Genesis Medical Group, LLC.
Prosthetic/Orthotic Supplier in Lake Oswego, OR. Organization (NPI-2).
NPI number1457517138
StatusActive
Last updated in NPPESApr 3, 2012
Details
- NPI
- 1457517138
- Entity type
- Organization (NPI-2)
- Legal business name
- Genesis Medical Group, LLC.
- Organization subpart
- No
- Enumeration date
- Aug 1, 2008
- Last updated
- Apr 3, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 335E00000X | Prosthetic/Orthotic Supplier | 1355445-0 | OR | Yes |
Practice location
16679 Boones Ferry Rd Ste 215Lake Oswego, OR 97035-4368
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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