| Geromed, Llc | |
|
4675 S Grand Blvd Saint Louis MO 63111-1462 | |
| (314) 752-8600 | |
| (314) 752-8601 |
| Full Name | Geromed, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4675 S Grand Blvd, Saint Louis, Missouri |
| Authorized Official Name and Position | Tony Thien Tang (OWNER) |
| Authorized Official Contact | 3147528600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geromed, Llc 4675 S Grand Blvd Saint Louis MO 63111-1462 Ph: (314) 752-8600 | Geromed, Llc 4675 S Grand Blvd Saint Louis MO 63111-1462 Ph: (314) 752-8600 |
| NPI Number | 1184755118 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 05/27/2008 |
| Medicare PECOS PAC ID | 8820061187 |
|---|---|
| Medicare Enrollment ID | O20040817000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184755118 | NPI | - | NPPES |
| 208442400 | Medicaid | MO | |
| 508753001 | Medicaid | MO | |
| 208393702 | Medicaid | MO | |
| 1023026804 | Other | PROVIDER NPI | |
| 1417040114 | Other | PROVIDER NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Tony T Tang |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1417040114 PECOS PAC ID: 2860465390 Enrollment ID: I20040813000732 |
| Provider Name | Chantri Trinh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023026804 PECOS PAC ID: 5799761953 Enrollment ID: I20040816000319 |
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