Active NPI
Genoa Healthcare LLC
- Long Term Care Pharmacy
- Columbia, SC
National Provider Identifier
1811248412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 4 Harbison Way
Columbia, SC 29212-3402 - Phone
- (803) 731-0203
- Fax
- (866) 935-3629
- NPI assigned
- Sep 24, 2012
- 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
4 Harbison Way
Columbia, SC 29212-3402
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 SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200921000444 | SC | Part B Supplier - Pharmacy | 6608003652 | Practice locations: Columbia, SC |
National Provider Directory
National Provider Directory- Tax ID family
- Genoa Healthcare LLC
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
4 Harbison Way
Columbia, SC 29212
Phone (803) 731-0203
16 Berryhill Rd
Ste 109
Columbia, SC 29210
Phone (803) 731-0203
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Columbia, SC
- NPI 1184193542
-
- Pharmacist
- Columbia, SC
- NPI 1326321373
-
- Pharmacist
- Columbia, SC
- NPI 1952794810
-
- Pharmacist
- Columbia, SC
- NPI 1851784219
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348444800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1734998400000",
"number": "1811248412",
"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": "4 HARBISON WAY",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292123402",
"telephone_number": "803-731-0203",
"fax_number": "866-935-3629"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENOA HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2012-09-24",
"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 Columbia, SC
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.