Active NPI
Genoa Healthcare LLC
- Long Term Care Pharmacy
- Jackson, MS
National Provider Identifier
1720468911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 3450 Highway 80 W RM 68
Jackson, MS 39209 - Phone
- (601) 824-1667
- Fax
- (601) 825-6347
- 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
3450 Highway 80 W RM 68
Jackson, MS 39209
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 MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201104001130 | MS | Part B Supplier - Pharmacy | 6608003652 |
2 other NPIs on this enrollment Practice locations: Jackson, MS; Southaven, MS |
Other NPIs on the same Medicare enrollment 1
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 2
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Long Term Care Pharmacy
- Columbus, MS
- NPI 1104793975
-
- Long Term Care Pharmacy
- Southaven, MS
- NPI 1396280962
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Flowood, MS
- NPI 1275152043
-
- Pharmacist
- Jackson, MS
- NPI 1083522064
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": "1720468911",
"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": "3450 HIGHWAY 80 W RM 68",
"city": "JACKSON",
"state": "MS",
"postal_code": "39209",
"telephone_number": "601-824-1667",
"fax_number": "601-825-6347"
}
],
"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 Jackson, MS
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.