Provider Demographics
NPI:1942397344
Name:GENESIS ASC PARTNERS LLC
Entity Type:Organization
Organization Name:GENESIS ASC PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:3400 E JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8542
Mailing Address - Country:US
Mailing Address - Phone:517-708-3200
Mailing Address - Fax:517-272-1685
Practice Address - Street 1:3400 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8542
Practice Address - Country:US
Practice Address - Phone:517-708-3200
Practice Address - Fax:517-272-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI336817261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40021OtherBLUE CARE NETWORK
MI40021OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI2261985Medicaid
MIP00684067OtherRAILROAD MEDICARE
MI0P44410Medicare PIN