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General NPI Number Information
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NPI Number | 1962518118
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH SYSTEM
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 301 N 4TH AVE
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City | ELDRIDGE
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State | IA
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Zip | 52748-1113
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Country | US
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Telephone | 563-285-7232
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Fax | 563-285-6742
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Provider Business Mailing Address
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Address Line | 865 LINCOLN RD STE L10
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City | BETTENDORF
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State | IA
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Zip | 52722-4190
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Country | US
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Telephone | 563-355-9191
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Fax | 563-355-3419
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | MR. MARK G ROGERS
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Credential |
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Telephone | 563-421-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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