Genesis Wound Care of Pooler, LLC

Primary specialty

Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X

Legal business name

GENESIS WOUND CARE OF POOLER, LLC

Practice address

1000 Towne Center Blvd
Building 400
Pooler, GA 31322-4052

Phone

(912) 662-0223

Fax

(912) 662-0224

NPI assigned

Mar 29, 2016

Last updated

Mar 29, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

GENESIS WOUNDCAREAs reported in NPPES

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

Authorized official

Name

James Thomas O'Dare III

Title

Prinicipal

Phone

(856) 335-5025

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1467815472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 N ROUTE 73",
            "address_2": "SUITE A6",
            "city": "WEST BERLIN",
            "state": "NJ",
            "postal_code": "080919289",
            "telephone_number": "856-335-5025",
            "fax_number": "856-213-9269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD",
            "address_2": "BUILDING 400",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224052",
            "telephone_number": "912-662-0223",
            "fax_number": "912-662-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS WOUND CARE OF POOLER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS WOUNDCARE",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "O'DARE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRINICIPAL",
        "authorized_official_telephone_number": "856-335-5025",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.