MEDICARE: GENESIS HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	IA
2	207Q00000X	Family Medicine Physician	IL
3	207R00000X	Internal Medicine Physician	IA
4	207R00000X	Internal Medicine Physician	IL
5	207V00000X	Obstetrics & Gynecology Physician	IA
6	207V00000X	Obstetrics & Gynecology Physician	IL
7	208000000X	Pediatrics Physician	IA
8	208000000X	Pediatrics Physician	IL
9	207Q00000X	Family Medicine Physician	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477654945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	1351 W CENTRAL PARK AVE STE 4100
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1847
Country	:	US
Telephone Number	:	563-355-9191
Fax Number	:	563-355-3419

Provider Business Practice Location Address
First Line	:	1351 W CENTRAL PARK AVE STE 4100
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1847
Country	:	US
Telephone Number	:	563-355-9191
Fax Number	:	563-355-3419

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	MR. JOSEPH MALAS
Credential	:
Telephone Number	:	563-421-6508

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	03/01/2024

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Practice Location Address:

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1255337176 — BRENDA L SWANSON ARNP
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1306799176 — ELIZABETH C HOLLAND
Practice Location Address:

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52804-1707

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1477558799 — DR. KURT A ANDERSEN MD
Practice Location Address:

1345 W CENTRAL PARK AVE
DAVENPORT, IA
52804-1844

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1730184003 — GENA L.R. BENOIT MD
Practice Location Address:

1345 W CENTRAL PARK AVE
DAVENPORT, IA
52804-1844

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1396740361 — ANDREW A ANDRESEN MD
Practice Location Address:

1345 W CENTRAL PARK AVE
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Directions to “GENESIS HEALTH SYSTEM ” Practice Location

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