Provider Demographics
NPI:1790974541
Name:GENESIS HEALTH AND WELLNESS, PA
Entity Type:Organization
Organization Name:GENESIS HEALTH AND WELLNESS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-313-6348
Mailing Address - Street 1:4855 RIVERSTONE BLVD
Mailing Address - Street 2:STE. 103
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4377
Mailing Address - Country:US
Mailing Address - Phone:281-313-6348
Mailing Address - Fax:281-313-6349
Practice Address - Street 1:4855 RIVERSTONE BLVD
Practice Address - Street 2:STE. 103
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4377
Practice Address - Country:US
Practice Address - Phone:281-313-6348
Practice Address - Fax:281-313-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160693101Medicaid
TX00510VMedicare PIN