Healthcare Provider Details

I. General information

NPI: 1215674114
Provider Name (Legal Business Name): GERIATRIC INSTITUTE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 SE 5TH ST UNIT 101
OCALA FL
34472-1200
US

IV. Provider business mailing address

9613 SW 53RD CIR
OCALA FL
34476-4057
US

V. Phone/Fax

Practice location:
  • Phone: 214-810-3016
  • Fax:
Mailing address:
  • Phone: 214-810-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MARTIAL DUCHATELLIER
Title or Position: OWNER
Credential: PHD
Phone: 214-810-3016