Active NPI
Genoa Healthcare LLC
- Specialty Pharmacy
- Las Vegas, NV
National Provider Identifier
1629219290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialty Pharmacy
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 701 Shadow LN Ste 110
Las Vegas, NV 89106-4131 - Phone
- (702) 382-4176
- Fax
- (702) 382-4822
- NPI assigned
- Mar 11, 2009
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | |||
| Compounding Pharmacy | 3336C0004X | |||
| Specialty Pharmacy | 3336S0011X | Primary |
Addresses
Primary practice location
701 Shadow LN Ste 110
Las Vegas, NV 89106-4131
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (877) 719-6349
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201103001758 | NV | Part B Supplier - Pharmacy | 6608003652 |
4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Las Vegas, NV |
| O20211129001788 | NV | DME Supplier - Pharmacy | 6608003652 | Practice locations: Las Vegas, NV |
Other NPIs on the same Medicare enrollment 3
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 4
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Long Term Care Pharmacy
- Las Vegas, NV
- NPI 1003524752
-
- Long Term Care Pharmacy
- Las Vegas, NV
- NPI 1447737606
-
- Community/Retail Pharmacy
- Las Vegas, NV
- NPI 1902541477
-
- Long Term Care Pharmacy
- Las Vegas, NV
- NPI 1669040283
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236729600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1734998400000",
"number": "1629219290",
"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": "877-719-6349",
"fax_number": "877-719-6362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 SHADOW LN STE 110",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891064131",
"telephone_number": "702-382-4176",
"fax_number": "702-382-4822"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENOA HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-03-11",
"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": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
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.