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Organization

GENESIS MEDICAL GROUP, LLC.

Active
Parent organization
GENESIS MEDICAL GROUP, LLC.
Organization subpart
Yes

Provider details

NPI number
Legal business name
GENESIS MEDICAL GROUP, LLC.
Authorized official
WYATT J BROWN CPED (DIRECTOR OF OPERATION)
(503) 699-1911
Entity
Organization

Contact information

Practice address
1515 NW 18TH AVE, SUITE 100, PORTLAND, OR 97209-2516
(503) 699-1911
(503) 699-1912
Mailing address
16679 BOONES FERRY RD, 215, LAKE OSWEGO, OR 97035-4365
(503) 699-1911
(503) 699-1912

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Enumeration date
08/16/2012
Last updated
08/16/2012
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