Provider Demographics
NPI:1225426711
Name:GREATER GENESEE COUNTY ACO
Entity Type:Organization
Organization Name:GREATER GENESEE COUNTY ACO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMASANDRAPALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-4200
Mailing Address - Street 1:1020 CHARTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3584
Mailing Address - Country:US
Mailing Address - Phone:810-720-4200
Mailing Address - Fax:810-720-2711
Practice Address - Street 1:1397 S LINDEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4194
Practice Address - Country:US
Practice Address - Phone:810-720-4200
Practice Address - Fax:810-720-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty