| Genesisprimecare | |
|
1400 College Dr Texarkana TX 75503-3536 | |
| (903) 791-1110 | |
| (903) 791-9353 |
| Full Name | Genesisprimecare |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1400 College Dr, Texarkana, Texas |
| Authorized Official Name and Position | Carla Roadcap (CEO) |
| Authorized Official Contact | 9039273782 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesisprimecare Po Box 1326 Marshall TX 75671-1326 Ph: (903) 927-3782 | Genesisprimecare 1400 College Dr Texarkana TX 75503-3536 Ph: (903) 791-1110 |
| NPI Number | 1083006084 |
|---|---|
| Provider Enumeration Date | 02/27/2015 |
| Last Update Date | 08/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083006084 | NPI | - | NPPES |
| 347907301 | Medicaid | TX | |
| 211550002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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