Provider Demographics
NPI:1013199660
Name:GENESIS MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GENESIS MEDICAL ASSOCIATES, INC.
Other - Org Name:GENESIS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-369-9550
Mailing Address - Street 1:9066 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5395
Mailing Address - Country:US
Mailing Address - Phone:412-847-0066
Mailing Address - Fax:412-847-0067
Practice Address - Street 1:8150 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5232
Practice Address - Country:US
Practice Address - Phone:412-369-9550
Practice Address - Fax:412-369-9566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-05
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1982523OtherHIGHMARK BLUE SHIELD
PA001517153-0034Medicaid