Provider Demographics
NPI:1053461996
Name:GENESIS MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:GENESIS MEDICAL ASSOCIATES, INC
Other - Org Name:NORTHERN AREA FAMILY MEDICINE/GENESIS MEDICAL ASSOCIATES
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 1:8150 PERRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5200
Mailing Address - Country:US
Mailing Address - Phone:412-369-9550
Mailing Address - Fax:412-369-9566
Practice Address - Street 1:5700 CORPORATE DR STE 700
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5829
Practice Address - Country:US
Practice Address - Phone:412-630-2670
Practice Address - Fax:412-630-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
861322OtherHIGHMARK BLUE SHIELD
PA001517153-0040Medicaid