NPIMap

Organization Active NPI

Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Bowling Green, KY
National Provider Identifier
1962987826
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
GENOA HEALTHCARE LLC
Practice address
380 Suwannee Trail St Ste 109
Bowling Green, KY 42103-7956
Phone
(270) 495-0240
Fax
(270) 393-8818
NPI assigned
Sep 26, 2018
Last updated
Jan 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

380 Suwannee Trail St Ste 109
Bowling Green, KY 42103-7956

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 KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200925002634 KY Part B Supplier - Pharmacy 6608003652 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lexington, KY; Richmond, KY; Paducah, KY; Owensboro, KY; Mayfield, KY; Louisville, KY; Florence, KY; Danville, KY…

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Genoa Healthcare LLC757 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 10

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

380 Suwannee Trail St
Ste 109
Bowling Green, KY 42103
Phone (270) 495-0240

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705363200000",
    "number": "1962987826",
    "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": "380 SUWANNEE TRAIL ST STE 109",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037956",
            "telephone_number": "270-495-0240",
            "fax_number": "270-393-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-26",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "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": "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.

Verify at the official NPI Registry.