Provider Demographics
NPI:1396887295
Name:HCA GENESIS, INC.
Entity type:Organization
Organization Name:HCA GENESIS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-782-7400
Mailing Address - Street 1:218 STONE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3211
Mailing Address - Country:US
Mailing Address - Phone:315-782-7400
Mailing Address - Fax:
Practice Address - Street 1:218 STONE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3211
Practice Address - Country:US
Practice Address - Phone:315-782-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01226553Medicaid
NYB13227Medicare UPIN
NYG28287Medicare UPIN
NY332540Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER