Organization
GENOA HEALTHCARE OF TENNESSEE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE JASON (CONTRACTS ADMINISTRATOR)
(253) 218-0862
Entity
Organization
Contact information
Practice address
120 OMNI DR, MC MINNVILLE, TN 37110-1331
(931) 473-1066
(931) 473-1068
Mailing address
510 E MAIN ST, AUBURN, WA 98002-5502
(253) 218-0830
(253) 218-0835
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
4338
TN
333600000X
Pharmacy
4338
TN
3336L0003X
Long Term Care Pharmacy
Primary
4338
TN
Other
Enumeration date
08/27/2007
Last updated
09/02/2008
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