Provider Demographics
NPI:1598029258
Name:GENESIS MEDICAL CARE
Entity Type:Organization
Organization Name:GENESIS MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MARLING
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:864-644-8303
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641
Mailing Address - Country:US
Mailing Address - Phone:864-506-1414
Mailing Address - Fax:
Practice Address - Street 1:109 FLEETWOOD DR
Practice Address - Street 2:SUITE E
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2019
Practice Address - Country:US
Practice Address - Phone:864-644-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF2099261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5985Medicaid