| Genesis Eldercare Physician Services Llc | |
|
1104 Wesley Ave Bryan OH 43506 | |
| (419) 636-5071 | |
| Not Available |
| Full Name | Genesis Eldercare Physician Services Llc |
|---|---|
| Speciality | Internal Medicine - Geriatric Medicine |
| Location | 1104 Wesley Ave, Bryan, Ohio |
| Authorized Official Name and Position | Eric Shapiro (VICE PRESIDENT) |
| Authorized Official Contact | 4108327790 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Eldercare Physician Services Llc Po Box 62946 Baltimore MD 21264-2946 Ph: (410) 494-7607 | Genesis Eldercare Physician Services Llc 1104 Wesley Ave Bryan OH 43506 Ph: (419) 636-5071 |
| NPI Number | 1366840811 |
|---|---|
| Provider Enumeration Date | 12/16/2014 |
| Last Update Date | 08/05/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366840811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 201315000306 (Ohio) | Primary |
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