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	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1770699043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	865 LINCOLN RD
Second Line	:	SUITE L10
City	:	BETTENDORF
State	:	IA
Zip	:	52722-4190
Country	:	US
Telephone Number	:	563-355-9191
Fax Number	:	563-355-3419

Provider Business Practice Location Address
First Line	:	205 11TH ST
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275-9037
Country	:	US
Telephone Number	:	309-523-3116
Fax Number	:	309-523-3916

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	MR. MARK J KLEINSCHMIDT
Credential	:
Telephone Number	:	563-421-6513

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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