Basic Information
| Provider Information | |||||||||
| NPI: | 1952350100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERIATRIC MEDICINE ASSOCIATES, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST ANTHONY HOSPITAL SENIOR HEALTH CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800022 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641800022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036431099 | ||||||||
| FaxNumber: | 3036431176 | ||||||||
| Practice Location | |||||||||
| Address1: | 11700 W 2ND PL | ||||||||
| Address2: | PLAZA II STE 450 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038251234 | ||||||||
| FaxNumber: | 3033218121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2006 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | CAIN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3038251234 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | CU0562 | 01 | CO | MEDICARE RAILROAD | OTHER | 04005070 | 05 | CO | MEDICAID |