Provider Demographics
NPI:1962282822
Name:GENESIX, INC.
Entity type:Organization
Organization Name:GENESIX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-300-2025
Mailing Address - Street 1:3112 COQUINA WAY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2747
Mailing Address - Country:US
Mailing Address - Phone:406-300-2025
Mailing Address - Fax:
Practice Address - Street 1:3112 COQUINA WAY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2747
Practice Address - Country:US
Practice Address - Phone:406-300-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center