Provider Demographics
NPI:1144228636
Name:GLENN GENOVESE MD PA
Entity Type:Organization
Organization Name:GLENN GENOVESE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENOVESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-484-1500
Mailing Address - Street 1:PO BOX 50268
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-0268
Mailing Address - Country:US
Mailing Address - Phone:940-484-1500
Mailing Address - Fax:940-484-1700
Practice Address - Street 1:3120 MEDPARK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-6981
Practice Address - Country:US
Practice Address - Phone:940-484-1500
Practice Address - Fax:940-484-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7302207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169371502Medicaid
TX00595UMedicare PIN
TX169371502Medicaid