Healthcare Provider Details

I. General information

NPI: 1669425682
Provider Name (Legal Business Name): GENESIS EMERGENCY MEDICINE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W LIBERTY RD
ATOKA OK
74525-1621
US

IV. Provider business mailing address

PO BOX 11527
DAYTONA BEACH FL
32120-1527
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-3333
  • Fax:
Mailing address:
  • Phone: 386-274-7800
  • Fax: 386-274-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK K YATES
Title or Position: PRESIDENT
Credential: MD
Phone: 318-524-3018