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General NPI Number Information
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NPI Number | 1366540239
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Entity Type | Organization
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Legal Business Name | GENOA HEALTHCARE OF FLORIDA, LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1437 S BELCHER RD
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City | CLEARWATER
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State | FL
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Zip | 33764-2829
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Country | US
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Telephone | 727-533-9073
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Fax | 727-533-9184
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Provider Business Mailing Address
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Address Line | PO BOX 77030
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City | MINNEAPOLIS
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State | MN
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Zip | 55480-7730
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Country | US
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Telephone | 253-218-0830
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Fax | 253-217-4306
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Authorized Official
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Title or Position | CONTROLLER
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Name | RYAN NIEMEYER
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Credential |
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Telephone | 253-218-0830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH22102
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License Number State | FL
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