Genoa Healthcare, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

GENOA HEALTHCARE, LLC

Practice address

529 W Centennial Blvd
Springfield, OR 97477-2804

Phone

(541) 868-1682

Fax

(541) 868-1683

NPI assigned

May 3, 2006

Organization subpart

No

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

Authorized official

Name

Ryan Niemeyer

Title

Controller

Phone

(253) 218-0830

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Genoa Healthcare Doing business as

Tax ID family

Genoa Healthcare2 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.

• Genoa Healthcare

  • Pharmacist
  • Toledo, OH
  • NPI 1639581549
  NPD tax ID

Locations

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1497713739",
    "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": "529 W CENTENNIAL BLVD",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974772804",
            "telephone_number": "541-868-1682",
            "fax_number": "541-868-1683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "NIEMEYER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "253-218-0830"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "OR",
            "license": "002046",
            "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": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3814921",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005807",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231819",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genoa Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Justin Anthony George
• Carla Widell Gerber, LCSW
• Sierra Emily Gerhard
• Jana Germonprez, LMT

• Long Term Care Pharmacy in Springfield, OR
• Providers in Springfield, OR by specialty
• Long Term Care Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; 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.