NPIMap

Organization Active NPI

Genoa Healthcare of Minnesota, LLC

  • Pharmacy
  • Minneapolis, MN
National Provider Identifier
1376501510
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
262600-0 Issued in MN
Legal business name
GENOA HEALTHCARE OF MINNESOTA, LLC
Practice address
825 S 8TH St
Suite SL-10
Minneapolis, MN 55404-1208
Phone
(612) 332-6522
NPI assigned
May 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jodi Kersavage
Title
Site Implementation
Phone
(360) 601-2122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 262600-0 MN Primary

Addresses

Primary practice location

825 S 8TH St
Suite SL-10
Minneapolis, MN 55404-1208

Mailing address

510 E Main St
Auburn, WA 98002-5502
Phone (360) 218-0830

National Provider Directory

National Provider Directory
Tax ID family
Genoa Healthcare Minnesota2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

825 S 8th St
Ste SL10
Minneapolis, MN 55404
Phone (612) 332-8500

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376501510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 E MAIN ST",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980025502",
            "telephone_number": "360-218-0830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 S 8TH ST",
            "address_2": "SUITE SL-10",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041208",
            "telephone_number": "612-332-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE OF MINNESOTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KERSAVAGE",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "SITE IMPLEMENTATION",
        "authorized_official_telephone_number": "360-601-2122"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MN",
            "license": "262600-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.