COLLABORATIVE GERIATRICS, INC. (NPI# 1629004221) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629004221 |
| Entity Type | Organization |
| Organization Name | COLLABORATIVE GERIATRICS, INC. |
| Practice Address |
414 Mahoganywood Dr Milton WV 25541-1181 |
| Mailing Address |
Po Box 979 Culloden WV 25510-0979 |
| Practice Telephone | 3047438007 |
| Practice Fax Number | 3047431704 |
| Mailing Telephone | 3047438007 |
| Mailing Fax Number | 3047431704 |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | COURTNEY BROOKE TAYLOR (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Telephone | 3047438007 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
21327 | WV | Allopathic & Osteopathic Physicians |
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
1601 | WV | Allopathic & Osteopathic Physicians |
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
20005 | WV | Allopathic & Osteopathic Physicians |
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
14713 | WV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | 0040807000 | 05 |
| Street Address |
414 MAHOGANYWOOD DR |
| City | MILTON |
| State | WV |
| Zip Code | 25541-1181 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598979320 | Ambryan L White | Family Medicine | 414 Mahoganywood Dr, Milton, WV 25541-1181 | 2007-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215570601 | Mark Halcombe | Massage Therapist | 1208 Trenol Rd., Milton, WV 25541 | 2019-10-18 |
| 1285285528 | Amy Conrad | Technician | 1233 Glenwood St, Milton, WV 25541 | 2019-09-27 |
| 1841849981 | Penny Blake | Technician | 248 Woodmire Drive, Milton, WV 25541 | 2019-09-11 |
| 1013407691 | Brandi Raelynn Krismer | Massage Therapist | Suite 5 Perry Morris Square, Milton, WV 25541 | 2018-05-18 |
| 1548457922 | Bogren Chiropractic Health Center | Chiropractor | 332 East Main Street, Milton, WV 25541 | 2007-09-28 |
| 1255424248 | Donald G Klinestiver | Family Medicine | 1028 Mason St, Milton, WV 25541 | 2006-10-02 |
| 1093730624 | Linda Ann Eakle | Family Medicine | 1509 W Main Street, Milton, WV 25541 | 2006-07-13 |
| 1841288438 | Connie Sue Boggess | Occupational Therapist | 2216 Newmans Branch Road, Rural Route 3 Box 397, Milton, WV 25541 | 2005-10-09 |
| 1659721496 | Jessica D. Lewis | Nurse Practitioner | 1 Harbour Way, Milton, WV 25541 | 2016-06-13 |
| 1770999120 | Kristy M Ferguson | Specialist | 1109 Main St, Milton, WV 25541 | 2014-07-07 |
| Find all providers in zip 25541 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598979320 | Ambryan L White | Family Medicine | 414 Mahoganywood Dr, Milton, WV 25541-1181 | 2007-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316436694 | Erona Reza | Family Medicine | 6040 University Town Centre Drive, Morgantown, WV 26501-2421 | 2018-05-02 |
| 1013136464 | Mehran Khajavi | Family Medicine | 1004 Sushruta Dr Ste C, Martinsburg, WV 25401-8801 | 2007-04-24 |
| 1063515054 | Melchor F Vidal | Family Medicine | 27545 Daniel Boone Prkwy, Racine, WV 25165 | 2006-09-06 |
| 1568455442 | Alan L. Barnett | Family Medicine | 933 Cheat Rd, Morgantown, WV 26508-5631 | 2005-08-25 |
| 1548252281 | Vincent Walter Delagarza | Family Medicine | 1 Stadium Drive, Health Sciences Center, Morgantown, WV 26505 | 2005-08-18 |
| 1437426780 | Summersville Family Medicine Inc | Family Medicine | 211 Merchants Walk, Shopping Center, Summersville, WV 26651-1901 | 2011-11-30 |
| 1821162207 | William Lee Harris | Family Medicine | 3100 Maccorkle Ave Se, Suite 307, Charleston, WV 25304-1223 | 2006-11-20 |
| 1821180530 | William C Mercer | Family Medicine | 58 16th St, 3rd Floor, Wheeling, WV 26003-3660 | 2006-09-29 |
| 1184654832 | Sivaparvati Thagirisa | Family Medicine | One Medical Center Drive, Louis A. Johnson Va Medical Center, Diagnostic Service, Clarksburg, WV 26301 | 2006-07-04 |
| 1275576514 | Gary L Knepp | Family Medicine | 400 N Jefferson St, Lewisburg, WV 24901 | 2006-06-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.