Healthcare Provider Details

I. General information

NPI: 1841286010
Provider Name (Legal Business Name): GERIMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 CHAUTAUQUA AVE
NORMAN OK
73069-5508
US

IV. Provider business mailing address

PO BOX 108810
OKLAHOMA CITY OK
73101-8810
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-8901
  • Fax: 405-948-6507
Mailing address:
  • Phone: 405-947-8586
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number14739
License Number StateOK

VIII. Authorized Official

Name: DR. MARK HAWKINS ADAMS
Title or Position: PRESIDENT/ OWNER
Credential: MD
Phone: 405-231-8901