Healthcare Provider Details

I. General information

NPI: 1518198324
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 53RD AVE
BETTENDORF IA
52722-7546
US

IV. Provider business mailing address

865 LINCOLN RD STE. L10
BETTENDORF IA
52722-4190
US

V. Phone/Fax

Practice location:
  • Phone: 563-383-2686
  • Fax: 563-383-2572
Mailing address:
  • Phone: 563-355-9200
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK G. ROGERS
Title or Position: VP OF FINANCE, CFO
Credential: MD
Phone: 563-421-6513