Provider Demographics
NPI:1336888163
Name:GENNEVE MEDICAL P.C.
Entity Type:Organization
Organization Name:GENNEVE MEDICAL P.C.
Other - Org Name:GENNEV
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF HEALTH ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-450-9886
Mailing Address - Street 1:11335 NE 122ND WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6933
Mailing Address - Country:US
Mailing Address - Phone:206-895-4292
Mailing Address - Fax:833-931-1081
Practice Address - Street 1:11335 NE 122ND WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6933
Practice Address - Country:US
Practice Address - Phone:334-450-9886
Practice Address - Fax:833-931-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty