MEDICARE: NEW GENESIS MEDICAL HEALTHCARE SYSTEM

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1790842219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW GENESIS MEDICAL HEALTHCARE SYSTEM

Provider Business Mailing Address
First Line	:	8300 HOMESTEAD RD
Second Line	:	SUITE 5
City	:	HOUSTON
State	:	TX
Zip	:	77028-2145
Country	:	US
Telephone Number	:	713-633-6635
Fax Number	:	713-633-3643

Provider Business Practice Location Address
First Line	:	8300 HOMESTEAD RD
Second Line	:	SUITE 5
City	:	HOUSTON
State	:	TX
Zip	:	77028-2145
Country	:	US
Telephone Number	:	713-633-6635
Fax Number	:	713-633-3643

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. KEISHA M SMITH
Credential	:
Telephone Number	:	713-633-6635

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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