Healthcare Provider Details

I. General information

NPI: 1902186364
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E RUSHOLME ST
DAVENPORT IA
52803-2459
US

IV. Provider business mailing address

865 LINCOLN RD STE L10
BETTENDORF IA
52722-4159
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-6610
  • Fax: 563-421-7719
Mailing address:
  • Phone: 563-355-9200
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

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