MEDICARE: GENESYS DURABLE MEDICAL EQUIPMENT 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
1	332B00000X	Durable Medical Equipment & Medical Supplies	2264	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790727477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESYS DURABLE MEDICAL EQUIPMENT LLC

Provider Business Mailing Address
First Line	:	960 CESERY BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5608
Country	:	US
Telephone Number	:	904-745-5421
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 CESERY BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5608
Country	:	US
Telephone Number	:	904-745-5121
Fax Number	:	904-745-5339

Authorized Official
Title or Position	:	OWNER /PRESIDENT
Name	:	MR. SONNY U UKPONG SR.
Credential	:
Telephone Number	:	904-745-5121

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	06/15/2011

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