Provider Demographics
NPI:1306016274
Name:GENESIS MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:GENESIS MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAMULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-684-4153
Mailing Address - Street 1:220 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2838
Mailing Address - Country:US
Mailing Address - Phone:931-684-4153
Mailing Address - Fax:888-371-5180
Practice Address - Street 1:220 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2838
Practice Address - Country:US
Practice Address - Phone:931-684-4153
Practice Address - Fax:888-371-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care