Provider Demographics
NPI:1376913301
Name:GENESIS MEDICAL CONCEPTS, LLC
Entity Type:Organization
Organization Name:GENESIS MEDICAL CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-344-6642
Mailing Address - Street 1:1710 WILLOW CREEK CIR
Mailing Address - Street 2:STE 1
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9192
Mailing Address - Country:US
Mailing Address - Phone:877-343-3758
Mailing Address - Fax:541-852-4110
Practice Address - Street 1:2020 8TH AVE STE 222
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068
Practice Address - Country:US
Practice Address - Phone:503-344-6642
Practice Address - Fax:503-305-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2008974332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2008974OtherCITY OF LAKE OSWEGO BUSINESS LICENSE