MEDICARE: GENOA HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy
4	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1861117657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENOA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	707 S GRADY WAY STE 400
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-3246
Country	:	US
Telephone Number	:	253-218-0830
Fax Number	:	253-217-4306

Provider Business Practice Location Address
First Line	:	2400 NW 24TH ST STE P
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-6629
Country	:	US
Telephone Number	:	253-218-0830
Fax Number	:	253-217-4306

Authorized Official
Title or Position	:	SECRETARY
Name	:	KAREN BOHMER
Credential	:
Telephone Number	:	224-231-1833

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	01/18/2024

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Directions to “GENOA HEALTHCARE LLC ” Practice Location

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