MEDICARE: RM GENESIS HEALTHCARE

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	302R00000X	Health Maintenance Organization	2930	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085AM	OTHER	NC	BLUE CROSS BLUE SHIELD
2	617755	OTHER		CIGNA
3	264096200	OTHER	NC	FEDERAL WORKERS COMP
4	42898	OTHER	NC	PARTNERS
5	617755	OTHER	NC	UNITED HEALTH CARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861558512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RM GENESIS HEALTHCARE

Provider Business Mailing Address
First Line	:	4518 W MARKET ST STE A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1543
Country	:	US
Telephone Number	:	336-235-4022
Fax Number	:	336-235-4023

Provider Business Practice Location Address
First Line	:	4518 W MARKET ST STE A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1543
Country	:	US
Telephone Number	:	336-235-4022
Fax Number	:	336-235-4023

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. ROOSEVELT JOHN SMITH
Credential	:	DC
Telephone Number	:	336-235-4022

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	11/19/2009

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Directions to “RM GENESIS HEALTHCARE ” Practice Location

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