Healthcare Provider Details

I. General information

NPI: 1700958196
Provider Name (Legal Business Name): GENESIS RESPIRATORY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 GALLIA ST
NEW BOSTON OH
45662-5511
US

IV. Provider business mailing address

4132 GALLIA ST
NEW BOSTON OH
45662-5511
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-4363
  • Fax: 740-353-1938
Mailing address:
  • Phone: 740-354-4363
  • Fax: 740-353-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHMER.22248
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHMER.22248
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02-1054600
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number02-1054600
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHMER.22248
License Number StateOH

VIII. Authorized Official

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