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General NPI Number Information
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NPI Number | 1891163366
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Entity Type | Organization
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Legal Business Name | GENESIS PHYSICIAN ALLIANCE, INC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 2717 COMMERCIAL CENTER BLVD STE E200
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City | KATY
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State | TX
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Zip | 77494-6410
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Country | US
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Telephone | 832-712-5904
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 COMMERCIAL CENTER BLVD STE E200
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City | KATY
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State | TX
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Zip | 77494-6410
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Country | US
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Telephone | 832-712-5904
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Fax | 832-913-1173
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Authorized Official
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Title or Position | CREDENTIALING
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Name | FRAN MCSHAN
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Credential |
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Telephone | 832-913-5032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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