Provider Demographics
NPI:1053671990
Name:GENESIS TRANSPORTATION
Entity Type:Organization
Organization Name:GENESIS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COOK
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:401-338-0772
Mailing Address - Street 1:220 TAFT ST
Mailing Address - Street 2:APT. 7
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860
Mailing Address - Country:US
Mailing Address - Phone:401-338-0772
Mailing Address - Fax:
Practice Address - Street 1:220 TAFT ST
Practice Address - Street 2:APT 7
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-338-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)