Genesis Medical Diagnostics PLLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GENESIS MEDICAL DIAGNOSTICS PLLC

Practice address

9359 Interstate 37 Ste D
Corpus Christi, TX 78409-3200

Phone

(361) 248-4062

Fax

(832) 565-1921

NPI assigned

Aug 17, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Ewan D. Johnson, MD, PHD

Title

Ceo/Founder

Phone

(281) 415-6687

Specialties & licenses 1

Addresses

Other identifiers 3

Tax ID family

Genesis Medical Diagnostics PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Genesis Medical Diagnostics

  • Clinical Medical Laboratory
  • Tomball, TX
  • NPI 1912659459
  NPD tax ID
• Genesis Medical Diagnostics PLLC

  • Clinical Medical Laboratory
  • Houston, TX
  • NPI 1386396810
  NPD tax ID

Locations

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1538835939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14090 FM 2920 RD STE 345G",
            "city": "TOMBALL",
            "state": "TX",
            "postal_code": "773775549",
            "telephone_number": "281-415-6687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9359 INTERSTATE 37 STE D",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784093200",
            "telephone_number": "361-248-4062",
            "fax_number": "832-565-1921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4195 Naco Perrin Blvd",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782172505",
            "country_code": "US",
            "telephone_number": "210-276-0045",
            "fax_number": "832-565-1921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2329 Jacaman Rd Ste 10",
            "address_purpose": "LOCATION",
            "city": "Laredo",
            "state": "TX",
            "postal_code": "780416264",
            "country_code": "US",
            "telephone_number": "956-516-5978",
            "fax_number": "832-565-1921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GENESIS MEDICAL DIAGNOSTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "EWAN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "281-415-6687",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER- SAN ANTONIO LOCATION",
            "identifier": "45D2216609",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA  NUMBER-LAREDO LOCATION",
            "identifier": "45D2216579",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER-CORPUS CHRISTI LOCATION",
            "identifier": "45D2199395",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Griffin Geick, DO
• Andrea Elaine Geldmeier, DPT
• Garrett Christopher Gellerman, DPT
• Mark Wilson Geneser, MD
• Genesis Medical Diagnostics PLLC
• Genoa Healthcare LLC
• Herve F Gentile, MD
• Patrizia E Gentile
• Gentle Dental Spa PLLC
• Gentle Divine Touch Home Care & Concierge Services

• Clinical Medical Laboratory in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.