Provider Demographics
NPI:1386855286
Name:GENESYS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GENESYS REGIONAL MEDICAL CENTER
Other - Org Name:MCCREE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF MEDICAL EDUCATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAERE II
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-232-3522
Mailing Address - Street 1:PO BOX 2015
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48501-2015
Mailing Address - Country:US
Mailing Address - Phone:810-762-4359
Mailing Address - Fax:810-762-4526
Practice Address - Street 1:115 E PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-3307
Practice Address - Country:US
Practice Address - Phone:810-600-2438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16G0009OtherHEALTHPLUS OF MICHIGAN