Healthcare Provider Details

I. General information

NPI: 1760412068
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 41ST ST
MOLINE IL
61265-5016
US

IV. Provider business mailing address

2526 41ST ST
MOLINE IL
61265-5016
US

V. Phone/Fax

Practice location:
  • Phone: 309-792-7063
  • Fax: 309-764-9326
Mailing address:
  • Phone: 309-792-7063
  • Fax: 309-764-9326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001982
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071002883
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007310
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164002086
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036062709
License Number StateIL

VIII. Authorized Official

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