1336367044 NPI number — GENESYS INTEGRATED GROUP PRACTICE PC

Table of content: (NPI 1336367044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336367044 NPI number — GENESYS INTEGRATED GROUP PRACTICE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESYS INTEGRATED GROUP PRACTICE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336367044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3495 S CENTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48519-1455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-424-2007
Provider Business Mailing Address Fax Number:
810-743-1099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8447 HOLLY RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-603-0856
Provider Business Practice Location Address Fax Number:
810-603-1635
Provider Enumeration Date:
04/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARSON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
810-424-2007

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: UC250004 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0M23560D . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0992742 . This is a "HEALTHPLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".