| Genesis Eldercare Physician Services LLC | |
|
1240 Pinebrook Rd Venice FL 34285 | |
| (941) 488-6733 | |
| Not Available |
| Full Name | Genesis Eldercare Physician Services LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1240 Pinebrook Rd, Venice, Florida |
| 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 1240 Pinebrook Rd Venice FL 34285 Ph: (941) 488-6733 |
| NPI Number | 1063839611 |
|---|---|
| Provider Enumeration Date | 03/20/2014 |
| Last Update Date | 08/05/2019 |
| Medicare PECOS PAC ID | 9830002534 |
|---|---|
| Medicare Enrollment ID | O20140915001204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063839611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | () | Primary |
| Provider Name | Jon P Gaudino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639288137 PECOS PAC ID: 9537336342 Enrollment ID: I20120119000400 |
| Provider Name | Falon Blessing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699124560 PECOS PAC ID: 8325320500 Enrollment ID: I20170124000495 |
| Provider Name | Jennifer E Tribue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134669112 PECOS PAC ID: 8820373442 Enrollment ID: I20170322002443 |
| Provider Name | Jessica H Mckee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285159012 PECOS PAC ID: 6305112442 Enrollment ID: I20171018000274 |
| Provider Name | Diane M Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629521307 PECOS PAC ID: 7719249234 Enrollment ID: I20190621000769 |
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