1568406338 NPI number — GENIC HEALTHCARE SERVICES AND SUPPLY, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568406338 NPI number — GENIC HEALTHCARE SERVICES AND SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENIC HEALTHCARE SERVICES AND SUPPLY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568406338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9914 DERBY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTCHESTER
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60154-3768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-344-8130
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9914 DERBY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTCHESTER
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60154-3719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-344-8130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOODS
Authorized Official First Name:
TONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-344-8130

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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