Healthcare Provider Details

I. General information

NPI: 1124454947
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W 3RD ST
DAVENPORT IA
52802-1812
US

IV. Provider business mailing address

865 LINCOLN RD SUITE L10
BETTENDORF IA
52722-4190
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-0500
  • Fax: 563-326-1901
Mailing address:
  • Phone: 563-355-9200
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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