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General NPI Number Information
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NPI Number | 1285789511
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Entity Type | Organization
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Legal Business Name | GERICARES LLC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 5344 SPRING HILL DR
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City | SPRING HILL
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State | FL
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Zip | 34606-4562
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Country | US
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Telephone | 352-666-0790
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Fax | 352-666-0903
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Provider Business Mailing Address
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Address Line | 5344 SPRING HILL DR
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City | SPRING HILL
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State | FL
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Zip | 34606-4562
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Country | US
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Telephone | 352-666-0790
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Fax | 352-666-0903
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIMMY EDMOND
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Credential | M.D.
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Telephone | 352-666-0790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME81127
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License Number State | FL
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