| Genesis Eldercare Physician Services Llc | |
|
136 Davis Ln La Follette TN 37766 | |
| (423) 562-0760 | |
| Not Available |
| Full Name | Genesis Eldercare Physician Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 136 Davis Ln, La Follette, Tennessee |
| Authorized Official Name and Position | Eric Shapiro (VICE PRESIDENT) |
| Authorized Official Contact | 4108327790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 136 Davis Ln La Follette TN 37766 Ph: (423) 562-0760 |
| NPI Number | 1790188076 |
|---|---|
| Provider Enumeration Date | 10/01/2014 |
| Last Update Date | 08/05/2019 |
| Medicare PECOS PAC ID | 9830002534 |
|---|---|
| Medicare Enrollment ID | O20150617002292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790188076 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Barbara J Baird |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407899065 PECOS PAC ID: 7719972595 Enrollment ID: I20040420000405 |
| Provider Name | Melissa Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376791913 PECOS PAC ID: 2860551280 Enrollment ID: I20081030000159 |
| Provider Name | Shelly R Shempert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902218985 PECOS PAC ID: 6800018631 Enrollment ID: I20141112000820 |
| Provider Name | Crystal A Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699029462 PECOS PAC ID: 6002060100 Enrollment ID: I20190730004023 |
| Provider Name | Briana Viens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851766158 PECOS PAC ID: 5294038410 Enrollment ID: I20201110000527 |
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