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NPI Code Detail

MEDICARE: GENOA HEALTHCARE OF FL LLC

MEDICARE: GENOA HEALTHCARE OF FL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail PharmacyPH22102FL
2332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11020356OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1487665980
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENOA HEALTHCARE OF FL LLC
Provider Business Mailing Address
First Line : 510 EASTERN ST
Second Line :
City : AUBUURN
State : WA
Zip : 98002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1437 S BELCHER RD
Second Line :
City : CLEARWATER
State : FL
Zip : 33764-2829
Country : US
Telephone Number : 727-533-9073
Fax Number : 727-533-9184
Authorized Official
Title or Position : PRESIDENT
Name : KEVIN MARTYN
Credential :
Telephone Number : 753-218-0862
Provider Enumeration Date : 08/10/2006
Last Update Date : 09/11/2025

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Directions to “GENOA HEALTHCARE OF FL LLC ” Practice Location

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