Healthcare Provider Details

I. General information

NPI: 1134539653
Provider Name (Legal Business Name): BEYOND GERIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 S MYRTLE AVE
CLEARWATER FL
33756-3469
US

IV. Provider business mailing address

1227 S MYRTLE AVE
CLEARWATER FL
33756-3469
US

V. Phone/Fax

Practice location:
  • Phone: 727-939-6196
  • Fax: 727-350-9396
Mailing address:
  • Phone: 727-939-6196
  • Fax: 727-350-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY D EVANS
Title or Position: OWNER
Credential: MD
Phone: 727-939-6196