Organization
GENESIS SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID DESTRISAC MD (MEDICAL DIRECTOR)
(517) 272-1063
Entity
Organization
Contact information
Practice address
3400 E JOLLY RD, LANSING, MI 48910-8542
(517) 272-1063
(517) 272-1685
Mailing address
3400 E JOLLY RD, LANSING, MI 48910-8542
(517) 272-1063
(517) 272-1685
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
336817
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C37001
BCBS-2ND
MI
01
—
40369
BLUE CROSS BLUE SHIELD
MI
Enumeration date
03/07/2006
Last updated
03/13/2008
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