Organization
GENOA HEALTHCARE, LLC
Active
Other names
Genoa Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN NIEMEYER (CONTROLLER)
(253) 218-0830
Entity
Organization
Contact information
Practice address
529 W CENTENNIAL BLVD, SPRINGFIELD, OR 97477-2804
(541) 868-1682
(541) 868-1683
Mailing address
PO BOX 77030, MINNEAPOLIS, MN 55480-7730
(253) 218-0830
(253) 217-4306
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
002046
OR
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005807
—
OR
05
—
231819
—
OR
01
—
3814921
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/03/2006
Last updated
04/25/2012
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