| Genesis Eldercare Physician Services Llc | |
|
16605 Chestnut Glen Pl Louisville KY 40245 | |
| (410) 543-1957 | |
| Not Available |
| Full Name | Genesis Eldercare Physician Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 16605 Chestnut Glen Pl, Louisville, Kentucky |
| 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 16605 Chestnut Glen Pl Louisville KY 40245 Ph: (410) 543-1957 |
| NPI Number | 1033535828 |
|---|---|
| Provider Enumeration Date | 03/17/2014 |
| Last Update Date | 08/05/2019 |
| Medicare PECOS PAC ID | 9830002534 |
|---|---|
| Medicare Enrollment ID | O20140821002540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033535828 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| 363LA2200X | Nurse Practitioner - Adult Health | 0858289.09 (Kentucky) | Secondary |
| Provider Name | Harshul Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427213842 PECOS PAC ID: 0941378350 Enrollment ID: I20081010000696 |
| Provider Name | Taylor S Conner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295276400 PECOS PAC ID: 1153608989 Enrollment ID: I20170504001463 |
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