MEDICARE: GENESIS MEDICAL CENTER

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		ID

General Provider Information

NPI Number	:	1992741490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	10255 OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1430
Country	:	US
Telephone Number	:	208-367-7205
Fax Number	:

Provider Business Practice Location Address
First Line	:	10255 OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1430
Country	:	US
Telephone Number	:	208-367-7205
Fax Number	:

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	DR. KARL WATTS
Credential	:	MD
Telephone Number	:	208-367-7205

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/22/2020

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Directions to “GENESIS MEDICAL CENTER ” Practice Location

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