Genesis Family Practice, Llc
LBN: Genesis Family Practice, Llc
Genesis Family Practice, Llc is an health care organization with primary practice located at 1133 Saxon Blvd , Orange City FL 32763-8425. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Laboratories / Clinical Medical Laboratory. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Genesis Family Practice, Llc can be contacted via phone (386) 228-9700, or through Chanmugam, Jay Crossette via phone (386) 878-4137.
Contact Information
Primary practice address
1133 Saxon Blvd
Orange City FL 32763-8425
Phone: (386) 228-9700
Fax:
Website:
Authorized official contact:
Name: Chanmugam, Jay Crossette Doctor of Osteopathy (DO)
Phone: (386) 878-4137
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | OS8600 | Florida |
| Laboratories / Clinical Medical Laboratory | 291U00000X |
Profile Details
| NPI number | 1023369204 |
|---|---|
| LBN Legal business name | Genesis Family Practice, Llc |
| DBA Doing business as | |
| Authorized official | Chanmugam, Jay Crossette Doctor of Osteopathy (DO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 27th, 2012 |
| Last updated | Nov 28th, 2022 - about 2 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023369204 | NPPES |
| Florida | MEDICAID | 008488100 |
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