Healthcare Provider Details

I. General information

NPI: 1811170756
Provider Name (Legal Business Name): GERIATRIC HEALTHCARE SERVICES OF GREATER CINCINNATI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 HILL AVE
MIDDLETOWN OH
45044-4732
US

IV. Provider business mailing address

PO BOX 427
FLORENCE KY
41022-0427
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-6780
  • Fax:
Mailing address:
  • Phone: 513-569-6780
  • Fax: 859-372-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BRADLEY BRUNS
Title or Position: OWNER
Credential:
Phone: 859-372-0711