Genesis Medical Group LLC
Prosthetic/Orthotic Supplier in Portland, OR. Organization (NPI-2).
NPI number1013214014
StatusActive
Last updated in NPPESAug 14, 2012
Details
- NPI
- 1013214014
- Entity type
- Organization (NPI-2)
- Legal business name
- Genesis Medical Group LLC
- Organization subpart
- Yes
- Enumeration date
- Feb 28, 2011
- Last updated
- Aug 14, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 335E00000X | Prosthetic/Orthotic Supplier | – | – | Yes |
Practice location
10802 Se Washington StPortland, OR 97216-3118
Phone 503-699-1911 · Fax 503-699-1912
Mailing address
16679 Boones Ferry Rd Ste 215Lake Oswego, OR 97035-4368
Phone 503-699-1911 · Fax 503-699-1912
Authorized official
Wyatt James Brown
Director Of Operation
5036991911
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