=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780736439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH A GERACI, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 02/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 617 S 1ST ST
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75901-3933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-634-4383
-----------------------------------------------------
Fax | 936-634-4338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 617 S 1ST ST
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75901-3933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-634-4383
-----------------------------------------------------
Fax | 936-634-4338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RICHARD C. GERACI
-----------------------------------------------------
Credential | BC-HIS, ACA
-----------------------------------------------------
Telephone | 936-634-4383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 50187
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------