MEDICARE: GERIATRIC CARE ASSOCIATES, 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	208D00000X	General Practice Physician	MD044865L	PA

General Provider Information

NPI Number	:	1851558951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC CARE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	5801 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3833
Country	:	US
Telephone Number	:	215-471-8255
Fax Number	:	215-471-5506

Provider Business Practice Location Address
First Line	:	5801 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3833
Country	:	US
Telephone Number	:	215-471-8255
Fax Number	:	215-471-5506

Authorized Official
Title or Position	:	MANAGMENT/OWNER
Name	:	DR. DARRYL B. JACKSON
Credential	:	M.D.
Telephone Number	:	215-471-8255

Provider Enumeration Date	:	05/18/2008
Last Update Date	:	05/18/2008

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