=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144228636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLENN GENOVESE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2005
-----------------------------------------------------
Last Update Date | 02/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3120 MEDPARK DR SUITE 150
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76208-6981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-484-1500
-----------------------------------------------------
Fax | 940-484-1700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 50268
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76206-0268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-484-1500
-----------------------------------------------------
Fax | 940-484-1700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. GLENN GENOVESE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 940-484-1500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | H7302
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RS0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | H7302
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------