Provider Demographics
NPI:1679628762
Name:PHYSICIANS GERIATRIC HEALTH SERVICES INC
Entity type:Organization
Organization Name:PHYSICIANS GERIATRIC HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-553-0810
Mailing Address - Street 1:1804 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6016
Mailing Address - Country:US
Mailing Address - Phone:502-553-0810
Mailing Address - Fax:502-288-6603
Practice Address - Street 1:1804 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-6016
Practice Address - Country:US
Practice Address - Phone:502-553-0810
Practice Address - Fax:502-288-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25893207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000291217OtherANTHEM
KY1063431Medicaid
KY1063431Medicaid
KY1601201Medicare PIN
KY000000291217OtherANTHEM