Provider Demographics
NPI:1982967709
Name:GENESIS DME, INC.
Entity Type:Organization
Organization Name:GENESIS DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-285-5200
Mailing Address - Street 1:2501 PLANT AVE
Mailing Address - Street 2:2501 PLANT AVE
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6046
Mailing Address - Country:US
Mailing Address - Phone:912-285-5200
Mailing Address - Fax:912-285-9378
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 105 SEGHS
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-264-2005
Practice Address - Fax:912-264-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000891096AMedicaid
GA4144260004Medicare NSC