GENOA HEALTHCARE, LLC (NPI# 1356726400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356726400 |
| Entity Type | Organization |
| Organization Name | GENOA HEALTHCARE, LLC |
| Practice Address |
109 W Watauga Ave Ste 129 Johnson City TN 37604-5621 |
| Mailing Address |
Po Box 77030 Minneapolis MN 55480-7730 |
| Practice Telephone | 4239308999 |
| Practice Fax Number | 4232180284 |
| Mailing Telephone | 2532180830 |
| Mailing Fax Number | 2532174306 |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2020-03-12 |
| Authorized Official Name | WILLIAM GUPTAIL (COO) |
| Authorized Official Telephone | 2532180830 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
0000005682 | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2153638 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972103257 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 555 Towner St Ste 1120d, Ypsilanti, MI 48198-5723 | 2020-10-27 |
| 1477153757 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 299 W Railroad Ave Ste P, Crestview, FL 32536-4053 | 2020-10-27 |
| 1033719323 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 7001 Blue Ridge Blvd Ste P, Raytown, MO 64133-5629 | 2020-10-27 |
| 1326648601 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 225 Carlton Davidson Ln Rm 1, Coal Grove, OH 45638-2924 | 2020-10-27 |
| 1912507211 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 5690 Santa Teresita Drive, Suite A2, Room P1, Santa Teresa, NM 88008 | 2020-10-27 |
| 1760080238 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 3807 N 7th St Ste P, Phoenix, AZ 85014-5005 | 2020-10-15 |
| 1174121982 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 807 Lawn Ave Ste 104, Sellersville, PA 18960-1549 | 2020-10-14 |
| 1457959272 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 281 Laclair St Rm 135, Coos Bay, OR 97420-2988 | 2020-10-14 |
| 1811595622 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 2500 W Washington Ave Ste 103, Las Vegas, NV 89106-3731 | 2020-10-14 |
| 1245844000 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 1441 E 84th Pl Rm 120, Merrillville, IN 46410-6578 | 2020-08-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Washington State Corporations | GENOA HEALTHCARE, LLC | 18300 Cascade Ave S # 251, Tukwila, WA 98188 |
| Massachusetts Corporations | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Ohio Business Entities | GENOA HEALTHCARE, LLC | 510 East Main Street, Auburn, WA 98002 |
| Street Address |
109 W WATAUGA AVE STE 129 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-5621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199432 | Boones Creek Pharmacy, Inc. | Pharmacy | 4729 N Roan St Ste 2, Johnson City, TN 37615-3886 | 2020-09-18 |
| 1043221625 | Pns Inc | Pharmacy | 527 N State of Franklin Rd, Suite 1, Johnson City, TN 37604-8210 | 2006-08-10 |
| 1386244085 | Jj Beans At Mooneys LLC | Pharmacy | 1107 N Roan St, Johnson City, TN 37601-3901 | 2020-10-30 |
| 1952477598 | Nhc Healthcare-johnson City LLC | Pharmacy | 3209 Bristol Hwy, Johnson City, TN 37601-1515 | 2006-11-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164032546 | Polaris Pharmacy Services of Tennessee, LLC | Pharmacy | 7005 Wesbelt Drive, Nashville, TN 32709 | 2020-07-31 |
| 1386261030 | Jeffrey Allan Anderson | Pharmacy | 721 N Tennessee Ave, Etowah, TN 37331-1754 | 2020-06-29 |
| 1376171652 | Boatwright Drug Co., Inc | Pharmacy | 7899 Leroy Boatwright St, Millington, TN 38053-2137 | 2020-03-31 |
| 1245868850 | Seymour Pharmacy Inc. | Pharmacy | 10721 Chapman Hwy Ste 6, Seymour, TN 37865-4771 | 2020-03-30 |
| 1700423654 | Southland Ltc Pharmacy | Pharmacy | 482 Interstate Dr Ste L, Manchester, TN 37355-3485 | 2019-12-10 |
| 1104380930 | Fannon Drug Co. | Pharmacy | 606 E. Emory Rd, Powell, TN 37849 | 2019-01-25 |
| 1538663281 | Black Bear Pharmacy, Inc. | Pharmacy | 110 Keith St Sw Ste 1and2, Cleveland, TN 37311-5868 | 2018-03-19 |
| 1891231734 | Rams Pharmacy LLC | Pharmacy | 1210 Hazelwood Dr Ste D, Smyrna, TN 37167-3964 | 2017-01-17 |
| 1982056529 | Pharmblue Tennessee LLC | Pharmacy | 1113 Murfreesboro Rd Ste 319-b, Franklin, TN 37064-1306 | 2016-07-07 |
| 1043685852 | Rams Pharmacy LLC | Pharmacy | 412 Gallatin Pike N, Madison, TN 37115-3706 | 2015-12-04 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
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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.