1427132604 NPI number — GENESIS HEALTH SYSTEM

Table of content: (NPI 1427132604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427132604 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:
Provider Other Organization Name Type Code:
6
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:
1427132604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 ILLINI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVIS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61282-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-281-4000
Provider Business Mailing Address Fax Number:
309-281-4399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 ILLINI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61282-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-281-4000
Provider Business Practice Location Address Fax Number:
309-281-4399
Provider Enumeration Date:
10/25/2006

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: 282N00000X ; 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: 005428 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 106025 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 20241 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40275 . This is a "BLUE CROSS OF IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 363495480 . This is a "TRICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 367389500 . This is a "ACS DEPT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0715789 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0973867 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50476 . This is a "BLUE CROSS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: A61282A5 . This is a "JOHN DEERE HC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: H210 . This is a "MIDLANDS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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