NPI 1013214014

Genesis Medical Group LLC

Organisation Prosthetic/Orthotic Supplier Portland, OR

Practice location

Address: 10802 SE Washington St, Portland, OR 97216-3118
Phone: (503) 699-1911
Fax: (503) 699-1912
Mailing address: 16679 Boones Ferry Rd STE 215, Lake Oswego, OR 97035-4368

Authorised official

Name: Wyatt James Brown
Title: Director of Operation
Phone: (503) 699-1911

Registered specialties

Prosthetic/Orthotic Supplier Primary

Suppliers Taxonomy 335E00000X

Other Prosthetic/Orthotic Supplier providers in Oregon →

Registry record

NPI: 1013214014
Entity type: Organization
NPI issued: 28 Feb 2011
Record last updated: 14 Aug 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.