MEDICARE: GENSIS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician
2	261Q00000X	Clinic/Center
3	302R00000X	Health Maintenance Organization
4	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1063849537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENSIS CENTER LLC

Provider Business Mailing Address
First Line	:	11721 MARKET PLACE AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6012
Country	:	US
Telephone Number	:	225-364-1886
Fax Number	:

Provider Business Practice Location Address
First Line	:	11721 MARKET PLACE AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6012
Country	:	US
Telephone Number	:	225-364-1886
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALVA WILLIAMS
Credential	:
Telephone Number	:	225-364-1886

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	02/05/2016

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