Provider Demographics
NPI:1609305077
Name:GENESIS OB ASSOCIATES, PC
Entity Type:Organization
Organization Name:GENESIS OB ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-330-4259
Mailing Address - Street 1:4944 WINDPLAY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9310
Mailing Address - Country:US
Mailing Address - Phone:916-330-5259
Mailing Address - Fax:916-357-7054
Practice Address - Street 1:300 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2574
Practice Address - Country:US
Practice Address - Phone:916-330-4259
Practice Address - Fax:916-357-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty