Provider Demographics
NPI:1174216121
Name:GERIATRIC AND PRIMARY CARE SERVICES, PLLC
Entity type:Organization
Organization Name:GERIATRIC AND PRIMARY CARE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HATTIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-217-9667
Mailing Address - Street 1:9658 PAGEWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5106
Mailing Address - Country:US
Mailing Address - Phone:281-217-9667
Mailing Address - Fax:
Practice Address - Street 1:9658 PAGEWOOD LANE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5106
Practice Address - Country:US
Practice Address - Phone:281-217-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty