Organization
GENESIS MEDICAL GROUP LLC
Active
Other names
Crooksville Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL D MASTERSON (ASSIST, TREASURER)
(740) 454-4637
Entity
Organization
Contact information
Practice address
712 CHINA STREET, CROOKSVILLE FAMILY CLINIC INC., CROOKSVILLE, OH 43731-1124
(740) 982-6872
(740) 982-5551
Mailing address
945 BETHESDA DRIVE, SUITE 200, ZANESVILLE, OH 43701-1880
(740) 454-4788
(740) 450-6157
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2270313
—
OH
Enumeration date
12/06/2006
Last updated
12/17/2013
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