Organization
GENESIS EMERGENCY MEDICINE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK K YATES MD (PRESIDENT)
(318) 524-3018
Entity
Organization
Contact information
Practice address
1200 W LIBERTY RD, ATOKA, OK 74525-1621
(580) 889-3333
Mailing address
PO BOX 11527, DAYTONA BEACH, FL 32120-1527
(386) 274-7800
(386) 274-7801
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159042002
—
AR
01
—
5F445
BLUE CROSS BLUE SHIELD
AR
01
—
DE3171
RAILROAD MEDICARE
AR
Enumeration date
05/19/2006
Last updated
09/27/2012
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