Geriatric Specialties of Arizona PC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

19651 Issued in AZ

Legal business name

GERIATRIC SPECIALTIES OF ARIZONA PC

Doing business as

Geriatric Specialties of Arizona

Practice address

6838 N 23Rd Ave
Phoenix, AZ 85015-1056

Phone

(602) 864-8800

NPI assigned

Apr 17, 2014

Reactivated

Nov 10, 2014

Last updated

Nov 10, 2014By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Geriatric Specialties of Arizona Doing business as

Tax ID family

Geriatric Specialist of Arizona2 organizations share this tax ID, including this one

Part of

Medvantx Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Geriatric Specialties of Arizona PC

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1225023377
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415577600000",
    "number": "1649690603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6838 N 23RD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850151056",
            "telephone_number": "602-864-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC SPECIALTIES OF ARIZONA PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-04-17",
        "last_updated": "2014-11-10",
        "deactivation_date": "2014-05-28",
        "reactivation_date": "2014-11-10",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "AZ",
            "license": "19651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Geriatric Specialties of Arizona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gerhard F Gomez MD LLC (Interventional Psychiatry of Arizona)
• Sara Gerhard, OT
• Geriatric and Family Mental Health Services, LLC
• Geriatric Solutions - Hov, LLC
• Geriatric Specialties of Arizona PC
• Andrea Geric
• Andrew Joseph Gerig, DO
• Gerinet Palliative Care, LLC (Health Essentials)
• Gerinet Palliative Care, LLC
• Stanley A Gering, M.D.

• Non-Pharmacy Dispensing Site in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Non-Pharmacy Dispensing Site in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.