Organization
RM GENESIS HEALTHCARE
Active
Other names
HealthSource
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROOSEVELT JOHN SMITH DC (CLINIC DIRECTOR)
(336) 235-4022
Entity
Organization
Contact information
Practice address
4518 W MARKET ST STE A, GREENSBORO, NC 27407-1543
(336) 235-4022
(336) 235-4023
Mailing address
4518 W MARKET ST STE A, GREENSBORO, NC 27407-1543
(336) 235-4022
(336) 235-4023
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
2930
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085AM
BLUE CROSS BLUE SHIELD
NC
01
—
264096200
FEDERAL WORKERS COMP
NC
01
—
42898
PARTNERS
NC
01
—
617755
UNITED HEALTH CARE
NC
01
—
617755
CIGNA
—
05
—
89085AM
—
NC
Enumeration date
12/28/2006
Last updated
11/19/2009
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