1861750242 NPI number — GENESYS HEALTH ENTERPRISES, INC.

Table of content: DR. DIANE L MCINTIRE MD (NPI 1689698409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861750242 NPI number — GENESYS HEALTH ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESYS HEALTH ENTERPRISES, INC.
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:
1861750242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 HEALTH PARK BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-9936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-603-8900
Provider Business Mailing Address Fax Number:
810-606-5255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 HEALTH PARK BLVD
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:
48439-7324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-606-5090
Provider Business Practice Location Address Fax Number:
810-606-5522
Provider Enumeration Date:
04/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMAN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
810-606-7282

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  5301005603 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 5301005603 , 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)





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