Healthcare Provider Details

I. General information

NPI: 1942397344
Provider Name (Legal Business Name): GENESIS ASC PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 E JOLLY RD
LANSING MI
48910-8542
US

IV. Provider business mailing address

3400 E JOLLY RD
LANSING MI
48910-8542
US

V. Phone/Fax

Practice location:
  • Phone: 517-708-3200
  • Fax: 517-272-1685
Mailing address:
  • Phone: 517-708-3200
  • Fax: 517-272-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number336817
License Number StateMI

VIII. Authorized Official

Name: JENETHA D MORAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 972-763-3893