Provider Demographics
NPI:1861472318
Name:GENESISCARE USA OF CALIFORNIA A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GENESISCARE USA OF CALIFORNIA A MEDICAL CORPORATION
Other - Org Name:GENESISCARE OF CALIFORNIA A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:C
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-931-7254
Mailing Address - Street 1:1419 SE 8TH TER STE 200
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3213
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:77840 FLORA RD
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4109
Practice Address - Country:US
Practice Address - Phone:760-200-8777
Practice Address - Fax:760-200-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095352Medicaid
CADD8190OtherRAILROAD MEDICARE
CAGR0095351Medicaid
CADD8190OtherRAILROAD MEDICARE
CAGR0095351Medicaid