Provider Demographics
NPI:1790727477
Name:GENESYS DURABLE MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:GENESYS DURABLE MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:U
Authorized Official - Last Name:UKPONG
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:904-745-5121
Mailing Address - Street 1:960 CESERY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5608
Mailing Address - Country:US
Mailing Address - Phone:904-745-5421
Mailing Address - Fax:
Practice Address - Street 1:960 CESERY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5608
Practice Address - Country:US
Practice Address - Phone:904-745-5121
Practice Address - Fax:904-745-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2264332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000378800Medicaid
FL000378800Medicaid
FL4945400001Medicare NSC