Ab Genuine Health, LLC
Organization Active NPI Family Medicine Physician · Nederland, TX
NPI 1568091072 · NPPES record last updated Jan 26, 2023
Key facts
- NPI
- 1568091072
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AB GENUINE HEALTH, LLC
- Practice address
- 324 N 14TH St
Nederland, TX 77627-4039 - Phone
- (409) 351-1507
- NPI assigned
- Apr 6, 2020
- Organization subpart
- No
Authorized official
- Name
- Anasha Bush Butler, FNP
- Title
- Owner of Entity
- Phone
- (409) 351-1507
Practitioners 2
-
Anasha Bush Butler, FNP
-
Connie Denise Johnson-Wiltz, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200410001579 | TX | Part B Supplier - Clinic/Group Practice | 5991134033 |
Receives reassigned benefits from 1 practitioner Practice locations: Port Arthur, TX; Nederland, TX |
National Provider Directory
Locations
1 Plaza Sq
Ste 107
Port Arthur, TX 77642
Phone (409) 217-4057
7980 Anchor Dr
Ste 1100
Port Arthur, TX 77642
Phone (409) 203-3525
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
324 N 14TH St
Nederland, TX 77627-4039
Mailing address
7635 Erie Dr
Nederland, TX 77627-5648
Phone (409) 351-1507
Other providers in Nederland, TX
- Chad Arwin Adkins
- Albert W Lyon MD PA
- Albert W Lyon MD PA
- Albritton & Gomez Dental Associates, PLLC
- Albritton Dental Associates
All providers in Nederland, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.