Provider Demographics
NPI:1396943791
Name:GENEVIEVE CONLEY
Entity type:Organization
Organization Name:GENEVIEVE CONLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-830-3002
Mailing Address - Street 1:550 W. DUTTON RD.
Mailing Address - Street 2:# B
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-6588
Mailing Address - Country:US
Mailing Address - Phone:541-830-3002
Mailing Address - Fax:541-830-3007
Practice Address - Street 1:550 W. DUTTON RD.
Practice Address - Street 2:# B
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-6588
Practice Address - Country:US
Practice Address - Phone:541-830-3002
Practice Address - Fax:541-830-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies