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General NPI Number Information
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NPI Number | 1073082350
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Entity Type | Organization
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Legal Business Name | GERIATRIC PRIMARY CARE PA
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1500 W FOXWOOD DR STE B
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City | RAYMORE
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State | MO
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Zip | 64083-9372
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Country | US
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Telephone | 850-377-0925
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Fax | 888-779-3217
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Provider Business Mailing Address
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Address Line | 12120 STATE LINE RD PMB 296
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City | LEAWOOD
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State | KS
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Zip | 66209-1254
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Country | US
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Telephone | 850-377-0925
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Fax | 888-779-3217
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Authorized Official
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Title or Position | OFFICER
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Name | MR. MARK BATTIST
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Credential | NP
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Telephone | 850-377-0925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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