Provider Demographics
NPI:1376746131
Name:JEFFREY J. GENATO
Entity Type:Organization
Organization Name:JEFFREY J. GENATO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEICHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-250-2023
Mailing Address - Street 1:6009 W PARKER RD STE 149 PMB 310
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6009 W PARKER RD STE 149 PMB 310
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8121
Practice Address - Country:US
Practice Address - Phone:972-250-2023
Practice Address - Fax:972-250-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1619931227Medicare UPIN