Healthcare Provider Details

I. General information

NPI: 1144022187
Provider Name (Legal Business Name): GENESIS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23599 AIRPORT RD STE B
COSHOCTON OH
43812-9276
US

IV. Provider business mailing address

23599 AIRPORT RD STE B
COSHOCTON OH
43812-9276
US

V. Phone/Fax

Practice location:
  • Phone: 740-722-9555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NORMAN
Title or Position: CSO
Credential:
Phone: 740-454-4773