Provider Demographics
NPI:1588780753
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 1:920 VETERANS DRIVE SUITE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640
Mailing Address - Country:US
Mailing Address - Phone:740-286-6737
Mailing Address - Fax:740-286-0261
Practice Address - Street 1:920 VETERANS DR UNIT C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-2175
Practice Address - Country:US
Practice Address - Phone:740-286-6737
Practice Address - Fax:740-286-0261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS RESPIRATORY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 335E00000X, 332B00000X
OHHMER.22254332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053521Medicaid
OH0203160007Medicare NSC