Organization
GENESIS MEDICAL GROUP, LLC.
Active
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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