Genesis Medical Group, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

GENESIS MEDICAL GROUP, LLC

Practice address

401 Lincoln Park Dr
New Lexington, OH 43764-1033

Phone

(740) 342-5107

NPI assigned

Apr 13, 2010

Organization subpart

Yes

Parent organization

GENESIS MEDICAL GROUP, LLCAs reported in NPPES

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

Authorized official

Name

Tim Raymond

Title

Chief Administrative Officer

Phone

(740) 454-4788

Specialties & licenses 1

Addresses

Part of

Genesis Medical Group LLC

Locations

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

{
    "created_epoch": "1271116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343088000000",
    "number": "1598081739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 BETHESDA DR STE 200",
            "city": "ZANESVILLE",
            "state": "OH",
            "postal_code": "437011880",
            "telephone_number": "740-454-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 LINCOLN PARK DR",
            "city": "NEW LEXINGTON",
            "state": "OH",
            "postal_code": "437641033",
            "telephone_number": "740-342-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS MEDICAL GROUP, LLC",
        "enumeration_date": "2010-04-13",
        "last_updated": "2012-07-24",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "740-454-4788"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Levi B Funk, M.ED, LPC
• Shelby Lynn Garey, QMHS
• Christina L Garner, ASSOCIATE
• Doris Lavon Garven
• William Whitney Garven
• Genesis Medical Group, LLC
• Bradley E Givens
• Glow House
• Nicole Goodman, APRN
• Amy Jo Green, LSW

• Rural Health Clinic/Center in New Lexington, OH
• Providers in New Lexington, OH by specialty
• Rural Health Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; 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.