Provider Demographics
NPI:1649368523
Name:GENESIS HEALTH SYSTEM
Entity type:Organization
Organization Name:GENESIS HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-421-6513
Mailing Address - Street 1:1118 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1235
Mailing Address - Country:US
Mailing Address - Phone:563-659-4200
Mailing Address - Fax:563-659-4223
Practice Address - Street 1:1118 11TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1235
Practice Address - Country:US
Practice Address - Phone:563-659-4200
Practice Address - Fax:563-659-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0044289Medicaid
IA0600627Medicaid
IA13928820OtherACS DEPT OF LABOR
IAIA10X2OtherJOHN DEERE HC ED
IAH72OtherMIDLANDS
IAIA10X7OtherJOHN DEERE HC PRIME CARE
IA0071084Medicaid
IA41054Medicaid
IAA5274204OtherJOHN DEERE HC
IL0816OtherBLUE CROSS OF IL
IA12895OtherBLUE CROSS IA PRIME CARE
IA0600221Medicaid
IA035487OtherHEALTH ALLIANCE
IA60062OtherBLUE CROSS OF IA ED
IAIA10X3OtherJOHN DEERE HC PROFEES
IAA52742X1OtherJOHN DEERE HC
IAIA10X2OtherJOHN DEERE HC ED
IA12895OtherBLUE CROSS IA PRIME CARE
IAIA10X2OtherJOHN DEERE HC ED
IA13928820OtherACS DEPT OF LABOR
IA0071084Medicaid
IACD1561Medicare PIN