Genesis Wellness & Pain Management Center

LBN: Providence Health Group Llc
Genesis Wellness & Pain Management Center is an health care organization with primary practice located at 300 W Osborn Rd Ste 110 , Phoenix AZ 85013-3922. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is the primary health care specialty. Providence Health Group Llc can be contacted via phone (602) 265-1210, or through Olade, Roger B via phone (404) 441-8752.

Contact Information

Primary practice address
300 W Osborn Rd Ste 110 Phoenix AZ 85013-3922
Phone: (602) 265-1210
Fax: (602) 265-1222
Website:
Map and Directions
Authorized official contact:
Name: Olade, Roger B Doctor of Medicine (MD)
Phone: (404) 441-8752

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X
Allopathic & Osteopathic Physicians / Pain Medicine 208VP0000X

Profile Details

NPI number 1841487709
LBN Legal business name Providence Health Group Llc
DBA Doing business as Genesis Wellness & Pain Management Center
Authorized official Olade, Roger B Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 25th, 2007
Last updated Jun 21st, 2011 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841487709 NPPES
Arizona MEDICAID 269526

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