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Organization
GENESIS WOUND CARE SERVICES
Active
Organization
GENESIS WOUND CARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK D ACUNA (BUSINESS MGR.)
(817) 875-0224
Entity
Organization
Contact information
Practice address
5201 WINTERBERRY CT., FT.WORTH, TX 76244
(817) 875-0224
(817) 431-5296
Mailing address
5201 WINTERBERRRY COURT, FT. WORTH, TX 76244
(817) 875-0224
(817) 431-5296
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0025SA
BLUE CROSS BLUE SHIELD OF TX
TX
05
—
202419201
—
TX
Enumeration date
11/26/2008
Last updated
12/12/2011
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