Provider Demographics
NPI:1720060924
Name:GENESIS ENTERPRISES, INC.
Entity Type:Organization
Organization Name:GENESIS ENTERPRISES, INC.
Other - Org Name:GENESIS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-466-0441
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:7058 HIGHWAY 64
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-0387
Mailing Address - Country:US
Mailing Address - Phone:901-466-0441
Mailing Address - Fax:901-466-0447
Practice Address - Street 1:7058 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-3208
Practice Address - Country:US
Practice Address - Phone:901-466-0441
Practice Address - Fax:901-466-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000465332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440484Medicaid
FLA0000OtherBLUE CROSS FL
VAV2336OtherHOMELINK
TN2678011OtherAETNA LIFE INSURANCE
TN3113340OtherBLUE CROSS BLUE SHIELD
MI7102000TN38060OtherBLUE CROSS MICHIGAN
MOGENESISOtherGEHA
TN1452445Medicaid
ARGENESIS ENTERPOtherBLUE CROSS AR
TNGENESIS ENTERPRISESOtherBC BS BLUE
TN000000114193OtherTENNCARE BETTER HEALTH
INGENESIS ENTERPRISESOtherCONSECO HEALTH
TN0005802578OtherAETNA
TNGENESISOtherUNITED HEALTHCARE AARP
TN1452445Medicaid
TN2678011OtherAETNA LIFE INSURANCE
TNGENESISOtherUNITED HEALTHCARE AARP
ARGENESIS ENTERPOtherBLUE CROSS AR
MS00440484Medicaid