Organization
GENESIS MEDICAL GROUP, LLC.
Active
Organization
GENESIS MEDICAL GROUP, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WYATT JAMES BROWN CPED (DIRECTOR OF OPERATION)
(503) 699-1911
Entity
Organization
Contact information
Practice address
16679 BOONES FERRY RD STE 215, LAKE OSWEGO, OR 97035-4368
(503) 699-1911
(503) 699-1912
Mailing address
16679 BOONES FERRY RD STE 215, LAKE OSWEGO, OR 97035-4368
(503) 699-1911
(503) 699-1912
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
1355445-0
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081911000
BLUE CROSS BLUE SHIELD
OR
05
—
500608071
—
OR
Enumeration date
08/01/2008
Last updated
04/03/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up