Basic Information
| Provider Information | |||||||||
| NPI: | 1720248818 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENESYS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10626 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729170626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797096702 | ||||||||
| FaxNumber: | 4797096730 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 WE KNIGHT DR | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729036249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797096702 | ||||||||
| FaxNumber: | 4797096730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2008 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | HICKMAN | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 4797096702 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | PENDING | AR | Y | Hospitals | General Acute Care Hospital |
No ID Information.