Provider Demographics
NPI:1942339015
Name:GENEVA WOODS HEALTH SUPPLIES PNW, LLC
Entity Type:Organization
Organization Name:GENEVA WOODS HEALTH SUPPLIES PNW, LLC
Other - Org Name:MYMEDSUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AFRASIABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-441-1312
Mailing Address - Street 1:PO BOX 94347
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6647
Mailing Address - Country:US
Mailing Address - Phone:509-588-7241
Mailing Address - Fax:866-583-9296
Practice Address - Street 1:6149 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5547
Practice Address - Country:US
Practice Address - Phone:360-456-5475
Practice Address - Fax:360-456-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604-124-465332B00000X, 332BP3500X, 332B00000X
WA603-447-258332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1942339015Medicaid
OR500736762Medicaid
WA2092007Medicaid
WA9060872Medicaid
0228390001Medicare NSC