Provider Demographics
NPI:1154554418
Name:GENESIS WELLNESS INSTITUTE FOR HEALTH, LLC
Entity type:Organization
Organization Name:GENESIS WELLNESS INSTITUTE FOR HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-419-0011
Mailing Address - Street 1:12201 MERIT DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2213
Mailing Address - Country:US
Mailing Address - Phone:972-419-0011
Mailing Address - Fax:972-239-4489
Practice Address - Street 1:12201 MERIT DR
Practice Address - Street 2:SUITE 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2213
Practice Address - Country:US
Practice Address - Phone:972-419-0011
Practice Address - Fax:972-239-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty