NPIMap

Organization Active NPI

Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Salem, OR
National Provider Identifier
1003093162
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
GENOA HEALTHCARE LLC
Practice address
2045 Silverton Rd NE Ste B
Salem, OR 97301-0100
Phone
(503) 364-3047
Fax
(503) 967-7165
NPI assigned
Jan 30, 2008
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Karen Bohmer
Title
Secretary
Phone
(224) 231-1833

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20200924001552 OR Part B Supplier - Pharmacy 6608003652 19 other NPIs on this enrollment
Practice locations: Grants Pass, OR; Salem, OR; Saint Helens, OR; Roseburg, OR; Portland, OR; Oregon City, OR; Ontario, OR; Newport, OR…

National Provider Directory

National Provider Directory
Tax ID family
Genoa Healthcare LLC (759 organizations share this tax ID)

Locations

2045 Silverton Rd NE
Ste P1
Salem, OR 97301

2045 Silverton Rd NE
Ste B
Salem, OR 97301
Phone (503) 364-3047

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

NPPES NPI Registry

Primary practice location

2045 Silverton Rd NE Ste B
Salem, OR 97301-0100

Mailing address

707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 17, 2024.

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1003093162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S GRADY WAY STE 400",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980573246",
            "telephone_number": "253-218-0830",
            "fax_number": "253-217-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 SILVERTON RD NE STE B",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973010100",
            "telephone_number": "503-364-3047",
            "fax_number": "503-967-7165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "BOHMER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "224-231-1833"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.