# GENESIS SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578530630
- **Authorized official:** DR. DAVID DESTRISAC MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (517) 272-1063

## Contact information

- **Practice address:** 3400 E JOLLY RD, LANSING, MI 48910-8542
- **Practice address phone:** (517) 272-1063
- **Practice address fax:** (517) 272-1685
- **Mailing address:** 3400 E JOLLY RD, LANSING, MI 48910-8542
- **Mailing address phone:** (517) 272-1063
- **Mailing address fax:** (517) 272-1685

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 336817 | MI | Yes |

## Other

- **Enumeration date:** 03/07/2006
- **Last updated:** 03/13/2008