GENESIS MEDICAL GROUP, LLC. (NPI# 1326290248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326290248 |
| Entity Type | Organization |
| Organization Name | GENESIS MEDICAL GROUP, LLC. |
| Practice Address |
1338 Commerce Ave Ste D Longview WA 98632-3743 |
| Mailing Address |
16679 Boones Ferry Rd Ste 215 Lake Oswego OR 97035-4368 |
| Practice Telephone | 5036991911 |
| Practice Fax Number | 5036991912 |
| Mailing Telephone | 5036991911 |
| Mailing Fax Number | 5036991912 |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2012-04-03 |
| Authorized Official Name | MR. WYATT JAMES BROWN (DIRECTOR OF OPERATION) |
| Authorized Official Telephone | 5036991911 |
| Authorized Official Credential | CPED |
| Is Organization Subpart | Y |
| Parent Organization Name | GENESIS MEDICAL GROUP, LLC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2005775 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457517138 | Genesis Medical Group, LLC. | Prosthetic/Orthotic Supplier | 16679 Boones Ferry Rd Ste 215, Lake Oswego, OR 97035-4368 | 2008-08-01 |
| 1740538115 | Genesis Medical Group, LLC. | Prosthetic/Orthotic Supplier | 1515 Nw 18th Ave, Suite 100, Portland, OR 97209-2516 | 2012-08-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | GENESIS MEDICAL GROUP, LLC | 10910 Domain Dr, Ste 300, Austin, TX 78758-7807 |
| Street Address |
1338 COMMERCE AVE STE D |
| City | LONGVIEW |
| State | WA |
| Zip Code | 98632-3743 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992366 | Honor Senior Care LLC | Home Health Aide | 1135 3rd Ave, Ste S101, Longview, WA 98632 | 2020-11-03 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1053870717 | Matthew Johnson | Physician Assistant | 900 Ocean Beach Hwy Ste 110, Longview, WA 98632 | 2019-03-12 |
| 1295205367 | Abid Valji | Occupational Therapist | Americana Health and Rehabilitation Center, 917 7th Ave, Longview, WA 98632 | 2018-11-30 |
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1982186318 | Linda Joan Mason | Licensed Practical Nurse | 1153 23rd Ave, Longview, WA 98632 | 2018-09-01 |
| 1891291910 | Ellen Sumner Hornbeak | Physical Therapist | 200 Triangle Shopping Ctr Ste 270, Longview, WA 98632 | 2018-04-05 |
| 1700399961 | Johnna Joyce Knapp | Speech-Language Pathologist | 2615 Lilac St, Longview, WA 98632 | 2017-11-09 |
| 1841711868 | Deborah Annette Burzynski | Registered Nurse | 1057 12th Avenue, Longview, WA 98632 | 2017-06-29 |
| 1598291122 | Cheyenne West | Counselor | 1616 10th Avenue, Longview, WA 98632 | 2017-05-02 |
| Find all providers in zip 98632 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184822793 | Steven G Mccullough and David W Holt Orthotics & Prosthetics, LLC | Prosthetic/Orthotic Supplier | 422 N Green St, Longview, TX 75601-6458 | 2007-07-05 |
| 1447344296 | Ava Inc. | Prosthetic/Orthotic Supplier | 1113 Vandercook Way, Suite 120, Longview, WA 98632-4024 | 2006-10-03 |
| 1750323713 | Edgar De La Fuente | Prosthetic/Orthotic Supplier | 719 N. Second Street, Longview, TX 75601-5316 | 2006-06-12 |
| 1740720366 | Hanger Clinic | Prosthetic/Orthotic Supplier | 1516 Hudson St, Suite 105, Longview, WA 98632-3083 | 2017-03-01 |
| 1629379490 | Steven Glenn Mccullough | Prosthetic/Orthotic Supplier | 422 N Green St, Longview, TX 75601-6458 | 2010-11-10 |
| 1992934053 | Prosthetic-orthotic Associates of East Texas, Inc. | Prosthetic/Orthotic Supplier | 414 E Loop 281, Suite 20, Longview, TX 75605-7930 | 2009-07-10 |
| 1508048984 | East Texas Prosthetic-orthotic Care | Prosthetic/Orthotic Supplier | 812 N 4th St, Longview, TX 75601-5413 | 2007-11-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699317784 | Preferred Orthotic and Prosthetic Services, Inc | Prosthetic/Orthotic Supplier | 520 S Cowley St Ste 104, Spokane, WA 99202-1315 | 2019-10-10 |
| 1629532536 | Preferred Orthotic and Prosthetic Services Inc | Prosthetic/Orthotic Supplier | 1708 Yakima Ave Ste 60, Tacoma, WA 98405 | 2019-01-24 |
| 1063906295 | Wmc Inc | Prosthetic/Orthotic Supplier | 2600 3rd Ave Ste B, Seattle, WA 98121-1293 | 2018-06-20 |
| 1174934707 | Nw Magnum LLC | Prosthetic/Orthotic Supplier | 108 Central Way, Kirkland, WA 98033-6106 | 2014-05-16 |
| 1205100013 | Cadence Biomedical, Inc. | Prosthetic/Orthotic Supplier | 146 N Canal St Ste 100, Seattle, WA 98103-8652 | 2012-02-27 |
| 1174807853 | Dental Sleep Therapy of Walla Walla Pllc | Prosthetic/Orthotic Supplier | 213 S 2nd Ave, Walla Walla, WA 99362-3002 | 2011-09-29 |
| 1922396159 | Hair Options | Prosthetic/Orthotic Supplier | 7106 Greenwood Ave N, Seattle, WA 98103-5038 | 2011-07-21 |
| 1083902746 | Seattle Cancer Care Alliance | Prosthetic/Orthotic Supplier | 207 Pontius Ave N, Suite 101, Seattle, WA 98109-5650 | 2011-07-15 |
| 1457645426 | Rcm Enterprise, LLC | Prosthetic/Orthotic Supplier | 8526 Delphi Rd Sw, Olympia, WA 98512-9349 | 2011-06-07 |
| 1417255019 | Beauty N Kurves LLC | Prosthetic/Orthotic Supplier | 513 1st Ave W, Seattle, WA 98119-3925 | 2011-03-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.