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General NPI Number Information
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NPI Number | 1063457562
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Entity Type | Organization
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Legal Business Name | GERIATRIC HEALTHCARE SERVICES, P.C.
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 4016 HUNTSCROFT LN
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City | WINSTON SALEM
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State | NC
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Zip | 27106-4777
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Country | US
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Telephone | 336-245-2764
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Fax | 336-245-2765
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Provider Business Mailing Address
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Address Line | PO BOX 24416
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City | WINSTON SALEM
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State | NC
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Zip | 27114-4416
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Country | US
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Telephone | 336-245-2764
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Fax | 336-923-2189
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CARLOS M IRUELA
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Credential |
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Telephone | 336-245-2764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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