Provider Demographics
NPI:1356373815
Name:GERIATRIC MEDICAL SERVICES INC.
Entity type:Organization
Organization Name:GERIATRIC MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-692-2118
Mailing Address - Street 1:PO BOX 19635
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73144-0635
Mailing Address - Country:US
Mailing Address - Phone:405-692-2118
Mailing Address - Fax:405-691-6499
Practice Address - Street 1:3545 NW 58TH ST STE 750
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4710
Practice Address - Country:US
Practice Address - Phone:405-692-2118
Practice Address - Fax:405-691-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20328261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522004OtherMEDICARE
OK100711480AOtherMEDICAID