| Genesis Eldercare Physician Services Llc | |
|
16605 Chestnut Glen Pl Louisville KY 40245 | |
| (410) 543-1957 | |
| Not Available |
| Full Name | Genesis Eldercare Physician Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 16605 Chestnut Glen Pl, Louisville, Kentucky |
| Authorized Official Name and Position | Eric Shapiro (VICE PRESIDENT) |
| Authorized Official Contact | 4108327790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Eldercare Physician Services Llc Po Box 62946 Baltimore MD 21264-2946 Ph: (410) 494-7607 | Genesis Eldercare Physician Services Llc 16605 Chestnut Glen Pl Louisville KY 40245 Ph: (410) 543-1957 |
| NPI Number | 1033535828 |
|---|---|
| Provider Enumeration Date | 03/17/2014 |
| Last Update Date | 08/05/2019 |
| Medicare PECOS PAC ID | 9830002534 |
|---|---|
| Medicare Enrollment ID | O20140821002540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033535828 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| 363LA2200X | Nurse Practitioner - Adult Health | 0858289.09 (Kentucky) | Secondary |
| Provider Name | Joan Shemwell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609921758 PECOS PAC ID: 5496649212 Enrollment ID: I20040212000048 |
| Provider Name | Christina A. Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215956644 PECOS PAC ID: 6901830843 Enrollment ID: I20050921000189 |
| Provider Name | Lorie Michelle Wardlow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336111673 PECOS PAC ID: 6608897111 Enrollment ID: I20051213000260 |
| Provider Name | Harshul Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427213842 PECOS PAC ID: 0941378350 Enrollment ID: I20081010000696 |
| Provider Name | Kathy D Short |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285660274 PECOS PAC ID: 9638175839 Enrollment ID: I20110204000207 |
| Provider Name | Achamma S Itticheria |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942415732 PECOS PAC ID: 9133385719 Enrollment ID: I20120726000114 |
| Provider Name | Kathleen J. Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790146926 PECOS PAC ID: 0547569402 Enrollment ID: I20160427000583 |
| Provider Name | Taylor S Conner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295276400 PECOS PAC ID: 1153608989 Enrollment ID: I20170504001463 |
| Provider Name | Rebecca Spicer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942835624 PECOS PAC ID: 3870922792 Enrollment ID: I20200327003052 |
| Provider Name | Jennifer Banschbach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225664725 PECOS PAC ID: 3274964440 Enrollment ID: I20200504002595 |
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