Provider Demographics
NPI:1568406338
Name:GENIC HEALTHCARE SERVICES AND SUPPLY, INC
Entity Type:Organization
Organization Name:GENIC HEALTHCARE SERVICES AND SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-344-8130
Mailing Address - Street 1:9914 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-3768
Mailing Address - Country:US
Mailing Address - Phone:708-344-8130
Mailing Address - Fax:
Practice Address - Street 1:9914 DERBY LN
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-3719
Practice Address - Country:US
Practice Address - Phone:708-344-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4934780001Medicare ID - Type UnspecifiedMEDICAL EQUIPMENT SUPPLY