Provider Demographics
NPI:1316929599
Name:GENESIS ENTERPRISES INC
Entity type:Organization
Organization Name:GENESIS ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-485-8600
Mailing Address - Street 1:1876 CRAIGSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4006
Mailing Address - Country:US
Mailing Address - Phone:855-485-8600
Mailing Address - Fax:314-485-1049
Practice Address - Street 1:1876 CRAIGSHIRE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4006
Practice Address - Country:US
Practice Address - Phone:314-485-8600
Practice Address - Fax:314-485-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140043923336C0004X
MO6217210001332BX2000X, 332B00000X
MO2004020806251F00000X
MO758 3HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144441OtherPK
MO197210OtherBCBS OF MISSOURI
MO684637OtherHEALTHLINK
MO230843OtherGHP
MO910530OtherCOVENTRY
MO230843OtherGROUP HEALTH PLAN
MO2020 22812 TRIOtherMERCY HEALTH PLANS
MO20202 2812 002OtherHEALTH NET FEDERAL SERVICES / TRICARE NORTH
MO758 3HHOtherSTATE LICENSE
MOQMP000003721935OtherMOLINA HEALTHCARE
MO1020916OtherUNITED HEALTHCARE
MO202022812TRIOtherMERCY HEALTH PLANS