Provider Demographics
NPI:1740337278
Name:GENVENTURES, INC.
Entity type:Organization
Organization Name:GENVENTURES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-421-6513
Mailing Address - Street 1:1803 E KIMBERLY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2027
Mailing Address - Country:US
Mailing Address - Phone:563-421-3308
Mailing Address - Fax:563-421-3307
Practice Address - Street 1:1803 E KIMBERLY RD
Practice Address - Street 2:SUITE A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2027
Practice Address - Country:US
Practice Address - Phone:563-421-3308
Practice Address - Fax:563-421-3307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENVENTURES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1019332BP3500X, 3336H0001X, 3336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1618961OtherNABP #
IA0160937Medicaid
IL=========002Medicaid
IA0794350006Medicare NSC