Provider Demographics
NPI:1982844122
Name:GENESIS MEDICAL
Entity Type:Organization
Organization Name:GENESIS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OF SALES
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-264-5322
Mailing Address - Street 1:PO BOX 1190
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-1190
Mailing Address - Country:US
Mailing Address - Phone:210-264-5322
Mailing Address - Fax:
Practice Address - Street 1:15319 SEVEN L TRL
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3806
Practice Address - Country:US
Practice Address - Phone:210-264-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-28
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies