NPIMap

Organization Active NPI

Genoa Healthcare LLC

  • Managed Care Organization Pharmacy
  • Golden Valley, MN
National Provider Identifier
1215445085
Registry record updated Mar 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Managed Care Organization PharmacyTaxonomy code 3336M0003X
Legal business name
GENOA HEALTHCARE LLC
Practice address
8441 Wayzata Blvd, Suite 340
Golden Valley, MN 55426-1372
Phone
(952) 746-8185
Fax
(952) 746-8187
NPI assigned
Jan 16, 2018
Last updated
Mar 24, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GENOA HEALTHCARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 24, 2023

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Long Term Care Pharmacy 3336L0003X NU
Managed Care Organization Pharmacy 3336M0003X NU Primary

Addresses

Primary practice location

8441 Wayzata Blvd, Suite 340
Golden Valley, MN 55426-1372

Mailing address

PO Box 77030
Minneapolis, MN 55480-7730
Phone (253) 218-0830

National Provider Directory

National Provider Directory
Part of
Genoa Healthcare LLC

Locations

8441 Wayzata Blvd
Ste 340
Golden Valley, MN 55426
Phone (952) 542-5511

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1215445085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 77030",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554807730",
            "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": "8441 WAYZATA BLVD, SUITE 340",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261372",
            "telephone_number": "952-746-8185",
            "fax_number": "952-746-8187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENOA HEALTHCARE LLC",
        "enumeration_date": "2018-01-16",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.