Provider Demographics
NPI:1861558512
Name:RM GENESIS HEALTHCARE
Entity type:Organization
Organization Name:RM GENESIS HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOSEVELT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-235-4022
Mailing Address - Street 1:4518 W MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1543
Mailing Address - Country:US
Mailing Address - Phone:336-235-4022
Mailing Address - Fax:336-235-4023
Practice Address - Street 1:4518 W MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1543
Practice Address - Country:US
Practice Address - Phone:336-235-4022
Practice Address - Fax:336-235-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2930302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085AMOtherBLUE CROSS BLUE SHIELD
617755OtherCIGNA
NC264096200OtherFEDERAL WORKERS COMP
NC42898OtherPARTNERS
NC617755OtherUNITED HEALTH CARE
NC89085AMMedicaid
617755OtherCIGNA