Provider Demographics
NPI:1184872400
Name:GENESYS REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:GENESYS REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING AND TA COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCULLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-908-0847
Mailing Address - Street 1:2989 VAN ZANDT RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3360
Mailing Address - Country:US
Mailing Address - Phone:248-674-4876
Mailing Address - Fax:248-674-6349
Practice Address - Street 1:2989 VAN ZANDT RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3360
Practice Address - Country:US
Practice Address - Phone:248-674-4876
Practice Address - Fax:248-674-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health