Organization
GENESIS MEDICAL GROUP II, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WYATT JAMES BROWN C.PED. (DIRECTOR OF OPERATION)
(503) 231-1529
Entity
Organization
Contact information
Practice address
10802 SE WASHINGTON ST, PORTLAND, OR 97216-3118
(503) 231-1529
(503) 231-7805
Mailing address
10802 SE WASHINGTON ST, PORTLAND, OR 97216-3118
(503) 231-1529
(503) 231-7805
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123617
—
OR
Enumeration date
06/26/2006
Last updated
06/28/2012
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