| NPI | 1194327098 |
|---|---|
| Doing Business As | PROVIDERGENIX HEALTHCARE SERVICES |
| Entity Type | Organization |
| Authorized Contact | THOMAS LEE RUSSELL CEO 419-406-0067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health |
| 207Q00000X Family Medicine | |
| 163W00000X Registered Nurse | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) | |
| 163WG0000X Registered Nurse, General Practice | |
| 163WH0200X Registered Nurse, Home Health | |
| 163WI0500X Registered Nurse, Infusion Therapy | |
| 207R00000X Internal Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-11-15 |
| Last Update Date | 2020-11-15 |