Provider Demographics
NPI:1033474291
Name:GENESIS NATURAL MEDICINE CENTER, PLC
Entity Type:Organization
Organization Name:GENESIS NATURAL MEDICINE CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UZICK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:520-495-4400
Mailing Address - Street 1:3920 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1428
Mailing Address - Country:US
Mailing Address - Phone:520-495-4400
Mailing Address - Fax:520-495-5400
Practice Address - Street 1:3920 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1428
Practice Address - Country:US
Practice Address - Phone:520-495-4400
Practice Address - Fax:520-495-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5617111N00000X
AZ01-624175F00000X
AZ83-357175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty