MEDICARE: GERIATRIC SERVICES, 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	05810/11.1	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356375687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	13 NORTHTOWN DR
Second Line	:	SUITE 220
City	:	JACKSON
State	:	MS
Zip	:	39211-3047
Country	:	US
Telephone Number	:	601-956-8276
Fax Number	:	601-709-0832

Provider Business Practice Location Address
First Line	:	13 NORTHTOWN DR
Second Line	:	SUITE 220
City	:	JACKSON
State	:	MS
Zip	:	39211-3047
Country	:	US
Telephone Number	:	601-956-8276
Fax Number	:	601-709-0832

Authorized Official
Title or Position	:	VP
Name	:	MRS. REBECCA H. SHELTON
Credential	:
Telephone Number	:	601-956-8276

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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Directions to “GERIATRIC SERVICES, INC. ” Practice Location

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