Healthcare Provider Details

I. General information

NPI: 1285865410
Provider Name (Legal Business Name): GENESIS DME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MAIN ST W
OAK HILL WV
25901-2943
US

IV. Provider business mailing address

135 N MAIN ST
WICHITA KS
67202-1400
US

V. Phone/Fax

Practice location:
  • Phone: 866-211-4817
  • Fax:
Mailing address:
  • Phone: 316-269-1414
  • Fax: 316-263-6019

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RYAN HODGE
Title or Position: MEMBER
Credential:
Phone: 316-269-1414