| Genesis Integrated Medicine | |
|
520 E Northwest Hwy Ste 102 Grapevine TX 76051 | |
| (817) 328-1922 | |
| (817) 328-1933 |
| Full Name | Genesis Integrated Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 520 E Northwest Hwy Ste 102, Grapevine, Texas |
| Authorized Official Name and Position | Stacy Lyles Hawkins (CREDENTIALING) |
| Authorized Official Contact | 3613563110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Integrated Medicine 2701 Matlock Rd Ste 105 Arlington TX 76015-2529 Ph: (817) 786-3040 | Genesis Integrated Medicine 520 E Northwest Hwy Ste 102 Grapevine TX 76051 Ph: (817) 328-1922 |
| NPI Number | 1164908463 |
|---|---|
| Provider Enumeration Date | 07/19/2018 |
| Last Update Date | 07/30/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164908463 | NPI | - | NPPES |
| 045797004 | Medicaid | TX | |
| 045797003 | Medicaid | TX | |
| 045797005 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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