Organization
GENESIS MEDICAL GROUP II, INC
Active
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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