1427097716 NPI number — GENESIS HEALTH SYSTEM

Table of content: (NPI 1427097716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427097716 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 DAVENPORT
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:
1427097716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1227 E RUSHOLME ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52803-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-421-3402
Provider Business Mailing Address Fax Number:
563-421-3419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 W CENTRAL PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52804-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-421-3402
Provider Business Practice Location Address Fax Number:
563-421-3419
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALAS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
563-421-6508

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6T033 . This is a "BLUE CROSS REHAB" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0600338 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com