Genoa Healthcare LLC
Organization Active NPI Long Term Care Pharmacy · Scottsburg, IN
NPI 1104417518 · NPPES record last updated Jan 26, 2024
Key facts
- NPI
- 1104417518
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 75 N 1St St RM 16
Scottsburg, IN 47170-1637 - Phone
- (812) 722-0053
- Fax
- (812) 803-3661
- NPI assigned
- Jan 28, 2021
- Organization subpart
- No
Authorized official
- Name
- Karen Bohmer
- Title
- Secretary
- Phone
- (224) 231-1833
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200715001620 | IN | Part B Supplier - Pharmacy | 6608003652 |
This NPI is an additional NPI on the enrollment Practice locations: Kendallville, IN; Jeffersonville, IN; Jasper, IN; Knox, IN; Kokomo, IN; Lafayette, IN; Lawrenceburg, IN; Logansport, IN… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | |||
| Long Term Care Pharmacy | 3336L0003X | Yes |
Addresses
Primary practice location
75 N 1St St RM 16
Scottsburg, IN 47170-1637
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
Other providers in Scottsburg, IN
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- Gardenside Dialysis LLC
- Gardner Street Emergency Physicians
- Sara Garrison
- Andrea Lee Gibson
- Gill Medical and Geriatrics Associates LLC
- Rupinder Gill
- Nicole Catherine Grayson
- Austin Thomas Hall
All providers in Scottsburg, IN · Long Term Care Pharmacy in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.