Provider Demographics
NPI:1467493213
Name:ASCENSION GENESYS HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION GENESYS HOSPITAL
Other - Org Name:GENESYS DOWNTOWN IM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYSICIAN SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-606-5389
Mailing Address - Street 1:5445 ALI DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-695-9996
Mailing Address - Fax:810-762-4526
Practice Address - Street 1:420 S. SAGINAW STREET
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502
Practice Address - Country:US
Practice Address - Phone:810-232-3522
Practice Address - Fax:810-762-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON69170Medicare PIN