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NPI Code Detail

MEDICARE: GENESIS MEDICAL EDUCATION FOUNDATION INC

MEDICARE: GENESIS MEDICAL EDUCATION FOUNDATION INC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianIA

General Provider Information

NPI Number : 1659322931
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS MEDICAL EDUCATION FOUNDATION INC
Provider Business Mailing Address
First Line : 1345 W CENTRAL PARK AVE
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-1844
Country : US
Telephone Number : 563-421-4400
Fax Number : 563-421-4449
Provider Business Practice Location Address
First Line : 1345 W CENTRAL PARK AVE
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-1844
Country : US
Telephone Number : 563-421-4400
Fax Number : 563-421-4449
Authorized Official
Title or Position : MANAGER OF OPERATIONS
Name : MRS. MARCIA ERICKSON
Credential : MHA
Telephone Number : 563-421-4405
Provider Enumeration Date : 05/12/2006
Last Update Date : 07/21/2022

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Directions to “GENESIS MEDICAL EDUCATION FOUNDATION INC ” Practice Location

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