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General NPI Number Information
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NPI Number | 1619278298
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH CLINIC & SERVICES, INC.
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 247 TAMIAMI TRL S
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City | NOKOMIS
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State | FL
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Zip | 34275-3136
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Country | US
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Telephone | 941-486-8500
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Fax | 941-412-9400
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Provider Business Mailing Address
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Address Line | 3333 N WASHINGTON BLVD SUITE 3
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City | SARASOTA
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State | FL
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Zip | 34234-6221
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. JAMES MCCLOUD
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Credential |
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Telephone | 941-363-1852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 4922
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License Number State | FL
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