Organization
GENESIS HEALTH SYSTEM
Active
Other names
Genesis Emergency Physician
Organization subpart
No
Provider details
NPI number
Authorized official
MARK G. ROGERS (VP OF FINANCE / CFO)
(563) 421-6513
Entity
Organization
Contact information
Practice address
1227 E RUSHOLME ST, DAVENPORT, IA 52803-2459
(563) 421-6610
(563) 421-7719
Mailing address
865 LINCOLN RD STE L10, BETTENDORF, IA 52722-4159
(563) 355-9200
(563) 355-3419
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0496083
—
IA
Enumeration date
08/17/2011
Last updated
08/22/2011
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