Healthcare Provider Details

I. General information

NPI: 1881786085
Provider Name (Legal Business Name): GENESIS FAMILY HEALTH CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 STONEGATE PARK
SAINT JOSEPH MI
49085-9144
US

IV. Provider business mailing address

1701 LAKE LANSING RD SUITE 100
LANSING MI
48912-3798
US

V. Phone/Fax

Practice location:
  • Phone: 269-428-8000
  • Fax: 269-428-2700
Mailing address:
  • Phone: 517-485-0001
  • Fax: 517-485-1138

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: ALAN SMIY
Title or Position: OWNER
Credential: MD
Phone: 269-428-8000