Provider Demographics
NPI:1992836407
Name:GENESIS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:GENESIS MEDICAL ASSOCIATES
Other - Org Name:WILLIAM S. ZILLWEGER 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 1:8150 PERRY HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5232
Mailing Address - Country:US
Mailing Address - Phone:412-369-9550
Mailing Address - Fax:412-369-9566
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:SUITE 3111
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5818
Practice Address - Country:US
Practice Address - Phone:412-366-2950
Practice Address - Fax:412-366-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
878076OtherBLUE SHIELD GROUP #