Provider Demographics
NPI:1215156179
Name:GENESIS WOMENS CENTER PA
Entity type:Organization
Organization Name:GENESIS WOMENS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-726-7667
Mailing Address - Street 1:800 MEDICAL CT E
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4612
Mailing Address - Country:US
Mailing Address - Phone:352-726-7667
Mailing Address - Fax:352-726-8193
Practice Address - Street 1:800 MEDICAL CT E
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4612
Practice Address - Country:US
Practice Address - Phone:352-726-7667
Practice Address - Fax:352-726-8193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG04804Medicare UPIN
FLS48423Medicare UPIN
FLH42303Medicare UPIN
FLS50134Medicare UPIN
FLI50386Medicare UPIN
FLC69410Medicare UPIN