Provider Demographics
NPI:1992506588
Name:GERIATRIC PRIMARY CARE OF INDIANA
Entity type:Organization
Organization Name:GERIATRIC PRIMARY CARE OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-377-0925
Mailing Address - Street 1:12120 STATE LINE RD # 296
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5354 W 62ND ST APT 176C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-6436
Practice Address - Country:US
Practice Address - Phone:850-377-0925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty