Organization
GENESIS MEDICAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL MILLER (EXEC. DIRECTOR)
(502) 813-8630
Entity
Organization
Contact information
Practice address
1866 CAMPUS PL, LOUISVILLE, KY 40299-2305
(502) 813-8630
(502) 371-5487
Mailing address
1866 CAMPUS PL, LOUISVILLE, KY 40299-2305
(502) 813-8630
(502) 371-5487
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097444
ANTHEM BCBS #
—
01
—
0005097517
AETNA PROVIDER #
—
05
—
009933653
—
AL
01
—
1013063
ACM MEDICAID#
—
05
—
200080970A
—
IN
05
—
2553848
—
OH
05
—
4535450
—
MI
05
—
4582393
—
TN
05
—
50001000
—
KY
05
—
9000490400
—
KY
Enumeration date
06/02/2006
Last updated
03/23/2015
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