Provider Demographics
NPI:1457331308
Name:GENESIS MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:GENESIS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-CANABATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-285-2415
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:MCS 549
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0890
Mailing Address - Country:US
Mailing Address - Phone:787-285-2415
Mailing Address - Fax:787-285-4590
Practice Address - Street 1:14 CALLE MIGUEL CASILLAS
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3638
Practice Address - Country:US
Practice Address - Phone:787-285-2415
Practice Address - Fax:787-285-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service