1649368523 NPI number — GENESIS HEALTH SYSTEM

Table of content: (NPI 1649368523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649368523 NPI number — GENESIS HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS HEALTH SYSTEM
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:
GENESIS MEDICAL CENTER DEWITT
Provider Other Organization Name Type Code:
3
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:
1649368523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1118 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DE WITT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52742-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-659-4200
Provider Business Mailing Address Fax Number:
563-659-4223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1118 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DE WITT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52742-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-659-4200
Provider Business Practice Location Address Fax Number:
563-659-4223
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CFO
Authorized Official Telephone Number:
563-421-6513

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0044289 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0600627 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13928820 . This is a "ACS DEPT OF LABOR" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA10X2 . This is a "JOHN DEERE HC ED" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: H72 . This is a "MIDLANDS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA10X7 . This is a "JOHN DEERE HC PRIME CARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0071084 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41054 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A5274204 . This is a "JOHN DEERE HC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0816 . This is a "BLUE CROSS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 12895 . This is a "BLUE CROSS IA PRIME CARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0600221 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 035487 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 60062 . This is a "BLUE CROSS OF IA ED" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA10X3 . This is a "JOHN DEERE HC PROFEES" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: A52742X1 . This is a "JOHN DEERE HC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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