Provider Demographics
NPI:1427132604
Name:GENESIS HEALTH SYSTEM
Entity type:Organization
Organization Name:GENESIS HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-421-6513
Mailing Address - Street 1:801 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1804
Mailing Address - Country:US
Mailing Address - Phone:309-281-4000
Mailing Address - Fax:309-281-4399
Practice Address - Street 1:801 ILLINI DR
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1804
Practice Address - Country:US
Practice Address - Phone:309-281-4000
Practice Address - Fax:309-281-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL005428OtherHEALTH ALLIANCE
IL106025OtherHEALTHLINK
IL20241Medicaid
IA40275OtherBLUE CROSS OF IA
IL363495480OtherTRICARE
IL367389500OtherACS DEPT OF LABOR
IA0715789Medicaid
IA0973867Medicaid
IL50476OtherBLUE CROSS IL
ILA61282A5OtherJOHN DEERE HC
ILH210OtherMIDLANDS
IL363495480OtherTRICARE
IL367389500OtherACS DEPT OF LABOR
IL006895400Medicare ID - Type UnspecifiedFEDERAL BLACK LUNG
IL=========402Medicaid
IL20241Medicaid
IL50476OtherBLUE CROSS IL
IL140275Medicare Oscar/Certification