Provider Demographics
NPI:1649526419
Name:GENESYS REGIONAL MEDICAL CENTRE
Entity type:Organization
Organization Name:GENESYS REGIONAL MEDICAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:YOKOSAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-606-5981
Mailing Address - Street 1:17102 THORNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9218
Mailing Address - Country:US
Mailing Address - Phone:443-254-6850
Mailing Address - Fax:
Practice Address - Street 1:1 GENESYS PKWY
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION ROOM 4595
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8065
Practice Address - Country:US
Practice Address - Phone:443-254-6850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100961282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital