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Genesis Medical Group II, INC

Prosthetic/Orthotic Supplier in Portland, OR. Organization (NPI-2).

NPI number1790712073
StatusActive
Last updated in NPPESJun 28, 2012

Details

NPI
1790712073
Entity type
Organization (NPI-2)
Legal business name
Genesis Medical Group II, INC
Organization subpart
No
Enumeration date
Jun 26, 2006
Last updated
Jun 28, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
335E00000X Prosthetic/Orthotic Supplier––Yes
332B00000X Durable Medical Equipment & Medical Supplies––

Practice location

10802 Se Washington St
Portland, OR 97216-3118

Phone 503-231-1529 · Fax 503-231-7805

Mailing address

10802 Se Washington St
Portland, OR 97216-3118

Phone 503-231-1529 · Fax 503-231-7805

Authorized official

Wyatt James Brown
Director Of Operation
5032311529

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