MEDICARE: GERIATRIC HEALTHCARE CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME91793	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME91793	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1316110190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC HEALTHCARE CENTER INC

Provider Business Mailing Address
First Line	:	6331 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4537
Country	:	US
Telephone Number	:	813-884-3678
Fax Number	:	813-884-3690

Provider Business Practice Location Address
First Line	:	6331 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4537
Country	:	US
Telephone Number	:	813-884-3678
Fax Number	:	813-884-3690

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARLOS ALBERTO SALAZAR
Credential	:	MD
Telephone Number	:	813-751-7557

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	02/03/2009

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