Provider Demographics
NPI:1790879070
Name:GENEVA WOODS HEALTH SUPPLIES AK, LLC
Entity Type:Organization
Organization Name:GENEVA WOODS HEALTH SUPPLIES AK, LLC
Other - Org Name:MYMEDSUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SYCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-697-1892
Mailing Address - Street 1:3674 E COUNTRY FIELD CIR STE C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5101
Mailing Address - Country:US
Mailing Address - Phone:907-631-4475
Mailing Address - Fax:866-498-9635
Practice Address - Street 1:3674 E COUNTRY FIELD CIR STE C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-631-4475
Practice Address - Fax:866-498-9635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1678549Medicaid
AK7636770003OtherMEDICARE DMEPOS