Basic Information
| Provider Information | |||||||||
| NPI: | 1629295092 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESYS REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2015 | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485012015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106065830 | ||||||||
| FaxNumber: | 8106065639 | ||||||||
| Practice Location | |||||||||
| Address1: | 4642 GENESYS PKWY | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484398067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106065830 | ||||||||
| FaxNumber: | 8106065639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | LABAERE DO | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL EDUCATION DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8107154300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 4G00009 | 01 | MI | HEATHPLUS GROUP # | OTHER |