MEDICARE: GERIATRIC ASSESSMENT CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1427444793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC ASSESSMENT CENTER LLC

Provider Business Mailing Address
First Line	:	40 CYPRESS CREEK PKWY
Second Line	:	SUITE 143
City	:	HOUSTON
State	:	TX
Zip	:	77090-3530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 CYPRESS CREEK PKWY
Second Line	:	SUITE 143
City	:	HOUSTON
State	:	TX
Zip	:	77090-3530
Country	:	US
Telephone Number	:	281-443-8226
Fax Number	:

Authorized Official
Title or Position	:	NP/OWNER
Name	:	LATRONICA T FISHER
Credential	:
Telephone Number	:	281-443-8226

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/14/2015

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