Organization Name: | GENESIS PHYSICIAN ALLIANCE, INC |
NPI Number: | 1891163366 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FRAN MCSHAN (CREDENTIALING) |
Mailing Address: | 2717 Commercial Center Blvd Ste E200 Katy |
State: | TX US |
Postal Code: | 774946410 |
Phone Number: | 8327125904 |
Fax Number: | |
NPI Enumeration Date: | 09/14/2015 |
NPI Last Update Date: | 09/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |