1720060924 NPI number — GENESIS ENTERPRISES, INC.

Table of content: (NPI 1720060924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720060924 NPI number — GENESIS ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS ENTERPRISES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENESIS MEDICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720060924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 387
Provider Second Line Business Mailing Address:
7058 HIGHWAY 64
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38060-0387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-466-0441
Provider Business Mailing Address Fax Number:
901-466-0447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7058 HIGHWAY 64
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38060-3208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-466-0441
Provider Business Practice Location Address Fax Number:
901-466-0447
Provider Enumeration Date:
11/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
901-466-0441

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000465 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00440484 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: A0000 . This is a "BLUE CROSS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2336 . This is a "HOMELINK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2678011 . This is a "AETNA LIFE INSURANCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3113340 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7102000TN38060 . This is a "BLUE CROSS MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: GENESIS . This is a "GEHA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1452445 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: GENESIS ENTERP . This is a "BLUE CROSS AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: GENESIS ENTERPRISES . This is a "BC BS BLUE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000114193 . This is a "TENNCARE BETTER HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: GENESIS ENTERPRISES . This is a "CONSECO HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0005802578 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: GENESIS . This is a "UNITED HEALTHCARE AARP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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