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General NPI Number Information
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NPI Number | 1114965134
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Entity Type | Organization
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Legal Business Name | GENESIS MEDICAL INC.
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 1866 CAMPUS PL
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City | LOUISVILLE
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State | KY
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Zip | 40299-2305
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Country | US
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Telephone | 502-813-8630
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Fax | 502-371-5487
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Provider Business Mailing Address
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Address Line | 1866 CAMPUS PL
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City | LOUISVILLE
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State | KY
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Zip | 40299-2305
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Country | US
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Telephone | 502-813-8630
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Fax | 502-371-5487
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Authorized Official
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Title or Position | EXEC. DIRECTOR
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Name | MR. SAMUEL MILLER
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Credential |
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Telephone | 502-813-8630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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