Provider Demographics
NPI:1467954016
Name:GENESIS ORTHOPEDICS & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:GENESIS ORTHOPEDICS & SPORTS MEDICINE LLC
Other - Org Name:GENESIS ORTHOPEDICS & SPORTS MEDICINE DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYTHEM
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHADID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-377-1188
Mailing Address - Street 1:2900 FOXFIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-377-1188
Mailing Address - Fax:630-377-7360
Practice Address - Street 1:2425 W 22ND ST STE 212
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4658
Practice Address - Country:US
Practice Address - Phone:630-377-1188
Practice Address - Fax:630-377-7360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS ORTHOPEDICS & SPORTS MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-28
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies