Provider Information for 1013272103
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GENOA HEALTHCARE LLC
Organization Subpart: NO
NPI: 1013272103
Last Updated: 2024-12-26
Certification Date: 2024-12-26
Certification Date: 2024-12-26
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1013272103 | ||||||||
| Enumeration Date | 2012-07-05 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: KAREN BOHMER Title: Secretary Phone: 2242311833 | ||||||||
| Mailing Address | 707 S GRADY WAY STE 400 RENTON, WA 98057-3246 United States Phone: 253-218-0830 | Fax:253-217-4306 | ||||||||
| Primary Practice Address | 1 SOUTHTOWNE DR POTOSI, MO 63664-5729 United States Phone: 314-200-0849 | Fax:573-436-8900 | ||||||||
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