Provider Demographics
NPI:1720248818
Name:GENESYS MEDICAL CENTER
Entity Type:Organization
Organization Name:GENESYS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-709-6702
Mailing Address - Street 1:PO BOX 10626
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0626
Mailing Address - Country:US
Mailing Address - Phone:479-709-6702
Mailing Address - Fax:479-709-6730
Practice Address - Street 1:3601 WE KNIGHT DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6249
Practice Address - Country:US
Practice Address - Phone:479-709-6702
Practice Address - Fax:479-709-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPENDING282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital