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General NPI Number Information
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NPI Number | 1700681459
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Entity Type | Organization
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Legal Business Name | GERIO PRIMARY CARE
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 556 N 2ND ST
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City | BREESE
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State | IL
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Zip | 62230-1650
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Country | US
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Telephone | 618-484-9030
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Fax | 855-583-1422
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Provider Business Mailing Address
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Address Line | 556 N 2ND ST
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City | BREESE
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State | IL
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Zip | 62230-1650
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Country | US
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Telephone | 618-484-9030
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Fax | 855-583-1422
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | JOHN A FLICK
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Credential |
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Telephone | 618-977-3608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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