Active NPI
Genoa Healthcare LLC
- Long Term Care Pharmacy
- Dothan, AL
National Provider Identifier
1386024560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 134 Prevatt Rd
Dothan, AL 36301-5427 - Phone
- (334) 699-3858
- Fax
- (334) 699-3868
- NPI assigned
- Jun 3, 2015
- Last updated
- Dec 24, 2024
- Organization subpart
- No
NPPES NPI Registry
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | Primary |
Addresses
Primary practice location
134 Prevatt Rd
Dothan, AL 36301-5427
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200917001175 | AL | Part B Supplier - Pharmacy | 6608003652 |
6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Attalla, AL; Bessemer, AL; Dothan, AL; Mobile, AL; Montgomery, AL; Scottsboro, AL |
Other NPIs on the same Medicare enrollment 5
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Genoa Healthcare LLC
Organizations with this tax ID in the same state 5
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Long Term Care Pharmacy
- Montgomery, AL
- NPI 1073993259
-
- Long Term Care Pharmacy
- Attalla, AL
- NPI 1225418403
-
- Long Term Care Pharmacy
- Bessemer, AL
- NPI 1235519414
-
- Long Term Care Pharmacy
- Scottsboro, AL
- NPI 1568348530
-
- Long Term Care Pharmacy
- Mobile, AL
- NPI 1821478017
Locations
134 Prevatt Rd
Dothan, AL 36301
Phone (334) 699-3858
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433289600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1734998400000",
"number": "1386024560",
"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": "134 PREVATT RD",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363015427",
"telephone_number": "334-699-3858",
"fax_number": "334-699-3868"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENOA HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-06-03",
"last_updated": "2024-12-24",
"certification_date": "2024-12-24",
"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": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 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.