Provider Demographics
NPI:1306826961
Name:GENESISCARE USA OF NORTH CAROLINA, PA
Entity Type:Organization
Organization Name:GENESISCARE USA OF NORTH CAROLINA, PA
Other - Org Name:GENESISCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-456-2690
Mailing Address - Street 1:1419 SE 8TH TER STE 200
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3213
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:20 MEDICAL PARK DR STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2493
Practice Address - Country:US
Practice Address - Phone:828-253-7077
Practice Address - Fax:828-253-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2023-09-25
Deactivation Date:2019-07-11
Deactivation Code:
Reactivation Date:2019-07-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013EJMedicaid
NCCJ5984OtherRAILROAD MEDICARE
NC89013EJMedicaid