Provider Demographics
NPI:1134785017
Name:GENESIS MEDICAL SUPPLY AND MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:GENESIS MEDICAL SUPPLY AND MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:ROCIO
Authorized Official - Last Name:LACEN RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-223-9176
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0887
Mailing Address - Country:US
Mailing Address - Phone:787-494-5252
Mailing Address - Fax:
Practice Address - Street 1:G10 AVENIDA PRINCIPAL SUITE 2
Practice Address - Street 2:URB BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-494-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies