Healthcare Provider Details

I. General information

NPI: 1396045951
Provider Name (Legal Business Name): GENESYS AMBULATORY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N CENTER RD
BURTON MI
48509-1429
US

IV. Provider business mailing address

1460 N CENTER RD
BURTON MI
48509-1429
US

V. Phone/Fax

Practice location:
  • Phone: 810-715-4620
  • Fax:
Mailing address:
  • Phone: 810-715-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANNE HERMAN
Title or Position: MANAGER
Credential:
Phone: 810-606-5000