Healthcare Provider Details

I. General information

NPI: 1669651154
Provider Name (Legal Business Name): GENEVA MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N COOPER ST SUITE 890
ARLINGTON TX
76011-5592
US

IV. Provider business mailing address

1521 N COOPER ST SUITE 890
ARLINGTON TX
76011-5592
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: ROSS CRUTCHFIELD
Title or Position: PRESIDENT
Credential:
Phone: 817-277-3600