MEDICARE: HCA GENESIS, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396887295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HCA GENESIS, INC.

Provider Business Mailing Address
First Line	:	218 STONE ST
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3211
Country	:	US
Telephone Number	:	315-782-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 STONE ST
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3211
Country	:	US
Telephone Number	:	315-782-7400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SUZANNE STEINAU
Credential	:
Telephone Number	:	315-782-7400

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/22/2020

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