MEDICARE: GENESIS DIAGNOSTIC CENTER 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
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1760440937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS DIAGNOSTIC CENTER INC

Provider Business Mailing Address
First Line	:	3960 PATIENT CARE WAY
Second Line	:	STE 109
City	:	LANSING
State	:	MI
Zip	:	48911-4275
Country	:	US
Telephone Number	:	517-853-9124
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 PATIENT CARE WAY
Second Line	:	STE 109
City	:	LANSING
State	:	MI
Zip	:	48911-4275
Country	:	US
Telephone Number	:	517-853-9124
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY G MESSENGER
Credential	:	MD
Telephone Number	:	517-702-2905

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/30/2009

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