Healthcare Provider Details

I. General information

NPI: 1235107236
Provider Name (Legal Business Name): GENESIS RESPIRATORY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CENTER ST
IRONTON OH
45638-1501
US

IV. Provider business mailing address

210 CENTER ST
IRONTON OH
45638-1501
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-4000
  • Fax: 740-533-9633
Mailing address:
  • Phone: 740-532-4000
  • Fax: 740-533-9633

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number02-1435050
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE CONN
Title or Position: VICE PRESIDENT
Credential:
Phone: 740-456-4363