MEDICARE: GENESIS FAMILY HEALTH CENTER, 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	261QP2300X	Primary Care Clinic/Center	4301073629	MI

General Provider Information

NPI Number	:	1942751334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS FAMILY HEALTH CENTER, PLLC

Provider Business Mailing Address
First Line	:	4064 RED ARROW HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9209
Country	:	US
Telephone Number	:	269-281-0773
Fax Number	:	269-281-7196

Provider Business Practice Location Address
First Line	:	4064 RED ARROW HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9209
Country	:	US
Telephone Number	:	269-281-0773
Fax Number	:	269-281-7196

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	ALAN NICHOLAS SMIY
Credential	:	M.D.
Telephone Number	:	269-281-0773

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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