Provider Demographics
NPI:1730248816
Name:GERIATRIC ASSOCIATES OF ZANESVILLE
Entity type:Organization
Organization Name:GERIATRIC ASSOCIATES OF ZANESVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:740-455-3304
Mailing Address - Street 1:3606 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1072
Mailing Address - Country:US
Mailing Address - Phone:740-455-3304
Mailing Address - Fax:740-455-3686
Practice Address - Street 1:712 CHINA ST
Practice Address - Street 2:
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731-1124
Practice Address - Country:US
Practice Address - Phone:740-982-6872
Practice Address - Fax:740-982-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0178249Medicaid
OH9300773Medicare PIN
OH9280426Medicare PIN
OH9280421Medicare PIN
OH9280424Medicare PIN
OH9300772Medicare PIN
OH9300771Medicare PIN
OH9280422Medicare PIN
OH9280429Medicare PIN
OH9280423Medicare PIN
OH9280427Medicare PIN
OH0178249Medicaid
OH9280428Medicare PIN