NPIMap

Organization Active NPI

Genoa Healthcare, LLC

  • Long Term Care Pharmacy
  • New Bern, NC
National Provider Identifier
1194216713
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
GENOA HEALTHCARE, LLC
Doing business as
Genoa Healthcare, LLC
Practice address
1309 Tatum Dr Ste 1
New Bern, NC 28560
Phone
(252) 772-4010
Fax
(252) 636-0590
NPI assigned
May 21, 2018
Last updated
Jun 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph Douglas
Title
Ceo
Phone
(815) 404-4871

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

1309 Tatum Dr Ste 1
New Bern, NC 28560

Mailing address

707 S Grady Way Ste 700
Renton, WA 98057-3243
Phone (253) 218-0830

Other identifiers 1

IdentifierTypeStateIssuer
2177788OtherPK

Other names 1

  • Genoa Healthcare, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200925002552 NC Part B Supplier - Pharmacy 6608003652 17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Asheville, NC; Wintston Salem, NC; Wilmington, NC; Shelby, NC; Raleigh, NC; Hillsborough, NC; Hickory, NC; Greensboro, NC…

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Locations

1309 Tatum Dr
Ste 1
New Bern, NC 28560
Phone (252) 772-4010

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1194216713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S GRADY WAY STE 700",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980573243",
            "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": "1309 TATUM DR STE 1",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "28560",
            "telephone_number": "252-772-4010",
            "fax_number": "252-636-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-21",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "815-404-4871"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2177788",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genoa Healthcare, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Genoa Healthcare, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Bern, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.