Provider Demographics
NPI:1700958196
Name:GENESIS RESPIRATORY SERVICES INC
Entity Type:Organization
Organization Name:GENESIS RESPIRATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-456-4363
Mailing Address - Street 1:4132 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5511
Mailing Address - Country:US
Mailing Address - Phone:740-354-4363
Mailing Address - Fax:740-353-1938
Practice Address - Street 1:4132 GALLIA ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5511
Practice Address - Country:US
Practice Address - Phone:740-354-4363
Practice Address - Fax:740-353-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER.22248332B00000X, 332BP3500X, 332BX2000X
OH02-1054600333600000X, 3336C0004X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0415296Medicaid
KY5400256300Medicaid
KY90254053Medicaid
WV014709500Medicaid
KY90254053Medicaid