Provider Demographics
NPI:1740219526
Name:ASCENSION GENESYS HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION GENESYS HOSPITAL
Other - Org Name:EAST FLINT FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-606-5893
Mailing Address - Street 1:1460 N CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1429
Mailing Address - Country:US
Mailing Address - Phone:810-715-4300
Mailing Address - Fax:
Practice Address - Street 1:1460 N CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1429
Practice Address - Country:US
Practice Address - Phone:810-715-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI70OB511860OtherBCBS
MI70OB511860OtherBCBS