| Genesis Primecare | |
|
1400 College Dr Texarkana TX 75503-3536 | |
| (903) 791-1110 | |
| (903) 791-9353 |
| Full Name | Genesis Primecare |
|---|---|
| Speciality | Clinic/Center |
| Location | 1400 College Dr, Texarkana, Texas |
| Authorized Official Name and Position | Carla Roadcap (CEO) |
| Authorized Official Contact | 9039273782 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Primecare Po Box 1326 Marshall TX 75671-1326 Ph: (903) 927-3782 | Genesis Primecare 1400 College Dr Texarkana TX 75503-3536 Ph: (903) 791-1110 |
| NPI Number | 1053663690 |
|---|---|
| Provider Enumeration Date | 10/05/2012 |
| Last Update Date | 06/13/2024 |
| Certification Date | 06/13/2024 |
| Medicare PECOS PAC ID | 8820038565 |
|---|---|
| Medicare Enrollment ID | O20130109000585 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053663690 | NPI | - | NPPES |
| 192226202 | Medicaid | TX | |
| 198049002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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