Provider Demographics
NPI:1508204041
Name:GENESIS PHYSICIANS MANAGEMENT CORP
Entity Type:Organization
Organization Name:GENESIS PHYSICIANS MANAGEMENT CORP
Other - Org Name:GENESIS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARRIDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-884-3334
Mailing Address - Street 1:755 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4613
Mailing Address - Country:US
Mailing Address - Phone:305-884-3334
Mailing Address - Fax:305-885-3334
Practice Address - Street 1:755 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4613
Practice Address - Country:US
Practice Address - Phone:305-884-3334
Practice Address - Fax:305-885-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7995111N00000X
FLME90910208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty