Provider Demographics
NPI:1144865783
Name:GERICARE MED SUPPLY INC
Entity type:Organization
Organization Name:GERICARE MED SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:713-376-4235
Mailing Address - Street 1:207 OVERBLUFF ST
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-3229
Mailing Address - Country:US
Mailing Address - Phone:281-860-0953
Mailing Address - Fax:
Practice Address - Street 1:207 OVERBLUFF ST
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-3229
Practice Address - Country:US
Practice Address - Phone:281-860-0953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty