Genesis Medical Diagnostics PLLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GENESIS MEDICAL DIAGNOSTICS PLLC

Practice address

2329 Jacaman Rd Ste 10
Laredo, TX 78041-6264

Phone

(956) 516-5978

Fax

(832) 565-1921

NPI assigned

Jul 23, 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, PHDNPI 1043521313

Title

Ceo/Founder

Phone

(281) 415-6687

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ewan Douglas Johnson, MD, PHD

  • Internal Medicine Physician
  • Tomball, TX
  • NPI 1043521313
  NPD (past) Authorized official

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1639742802",
    "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",
            "fax_number": "832-565-1921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2329 JACAMAN RD STE 10",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780416264",
            "telephone_number": "956-516-5978",
            "fax_number": "832-565-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL DIAGNOSTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-23",
        "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",
            "identifier": "45D2216579",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Laredo, TX
• Providers in Laredo, 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.