Genesis Eldercare Physician Services LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

201315000306 Issued in OH

Legal business name

GENESIS ELDERCARE PHYSICIAN SERVICES LLC

Practice address

1104 Wesley Ave
Bryan, OH 43506

Phone

(419) 636-5071

NPI assigned

Dec 16, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eric Shapiro

Title

Vice President

Phone

(410) 832-7790

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1366840811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 62946",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212642946",
            "telephone_number": "410-494-7607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 WESLEY AVE",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "43506",
            "telephone_number": "419-636-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS ELDERCARE PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "410-832-7790"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "201315000306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Friesen
• Karen S. Gallagher, PT
• Robin Garza
• Tara Garza, CNP
• Michelle Lynn Gee, MSSA, LWS
• Jaimi Geren, COTA/L
• Kathryn Lynn Gerig, M.S. CCC-SLP
• Jamie Gillett
• Richard Gilmer, DDS
• Kyuttza Glaser

• Geriatric Medicine (Internal Medicine) Physician in Bryan, OH
• Providers in Bryan, OH by specialty
• Geriatric Medicine (Internal Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.