MEDICARE: GENETICS MEDICAL GROUP PLLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1891651675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENETICS MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	7533 S CENTER VIEW CT STE R
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-5526
Country	:	US
Telephone Number	:	908-625-7887
Fax Number	:

Provider Business Practice Location Address
First Line	:	7533 S CENTER VIEW CT STE R
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-5526
Country	:	US
Telephone Number	:	908-625-7887
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC D THOMAS
Credential	:	MD
Telephone Number	:	908-625-7887

Provider Enumeration Date	:	12/24/2025
Last Update Date	:	12/24/2025

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