Provider Demographics
NPI:1679696934
Name:GENESIS RESPIRATORY SERVICES INC
Entity Type:Organization
Organization Name:GENESIS RESPIRATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-456-4363
Mailing Address - Street 1:11756 STATE ROUTE 41
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-8025
Mailing Address - Country:US
Mailing Address - Phone:937-544-2783
Mailing Address - Fax:937-544-8918
Practice Address - Street 1:11756 STATE ROUTE 41
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-8025
Practice Address - Country:US
Practice Address - Phone:937-544-2783
Practice Address - Fax:937-544-8918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS RESPIRATORY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 335E00000X
OHHMER.22251332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054910Medicaid
OH0054910Medicaid