Healthcare Provider Details

I. General information

NPI: 1376913301
Provider Name (Legal Business Name): GENESIS MEDICAL CONCEPTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NE ANDRESEN RD STE 150
VANCOUVER WA
98661-7355
US

IV. Provider business mailing address

2600 NE ANDRESEN RD STE 150
VANCOUVER WA
98661-7355
US

V. Phone/Fax

Practice location:
  • Phone: 503-344-6642
  • Fax: 503-305-7045
Mailing address:
  • Phone: 503-344-6642
  • Fax: 503-305-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2008974
License Number StateOR

VIII. Authorized Official

Name: TODD ERICKSON
Title or Position: OWNER
Credential:
Phone: 360-309-9177