Provider Demographics
NPI:1225378466
Name:GENESIS MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:GENESIS MEDICAL SERVICES, LLC
Other - Org Name:GENESIS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:DEON
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:202-421-0640
Mailing Address - Street 1:17923 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8960
Mailing Address - Country:US
Mailing Address - Phone:202-421-0640
Mailing Address - Fax:
Practice Address - Street 1:17923 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-8960
Practice Address - Country:US
Practice Address - Phone:202-421-0640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25495261QU0200X
OK23417261QU0200X
OK26003261QU0200X
OK25993261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care