Provider Demographics
NPI:1922280577
Name:GENESIS MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GENESIS MEDICAL ASSOCIATES, INC.
Other - Org Name:GMA/HECK & POLINSKI MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-369-9550
Mailing Address - Street 1:526 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1854
Mailing Address - Country:US
Mailing Address - Phone:412-931-7415
Mailing Address - Fax:412-931-7415
Practice Address - Street 1:8150 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5232
Practice Address - Country:US
Practice Address - Phone:412-369-9550
Practice Address - Fax:412-369-9566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS MEDICAL ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-05
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1990093OtherHIGHMARK BLUE SHIELD