Provider Demographics
NPI:1619278298
Name:GENESIS HEALTH CLINIC & SERVICES, INC.
Entity Type:Organization
Organization Name:GENESIS HEALTH CLINIC & SERVICES, INC.
Other - Org Name:GENESIS DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-363-1852
Mailing Address - Street 1:3333 N WASHINGTON BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-6221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:247 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3136
Practice Address - Country:US
Practice Address - Phone:941-486-8500
Practice Address - Fax:941-412-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 49221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty