Healthcare Provider Details

I. General information

NPI: 1750485173
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 MAPLECREST RD STE 10
BETTENDORF IA
52722-7709
US

IV. Provider business mailing address

865 LINCOLN RD STE L10
BETTENDORF IA
52722-4190
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-4620
  • Fax: 563-421-4625
Mailing address:
  • Phone: 563-355-9191
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK G ROGERS
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 563-421-6513