Provider Demographics
NPI:1801013271
Name:GENESYS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GENESYS REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAERE DO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-715-4300
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:810-606-5830
Mailing Address - Fax:810-606-5639
Practice Address - Street 1:4642 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8067
Practice Address - Country:US
Practice Address - Phone:810-606-5830
Practice Address - Fax:810-606-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7G00009OtherHEALTHPLUS GROUP #