Provider Demographics
NPI:1285464149
Name:GENESIS ACCOUNTABLE PHYSICIAN NETWORK, LLC
Entity type:Organization
Organization Name:GENESIS ACCOUNTABLE PHYSICIAN NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-403-3100
Mailing Address - Street 1:5429 LBJ FWY STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-2614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5429 LBJ FWY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-2614
Practice Address - Country:US
Practice Address - Phone:972-419-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty