Provider Demographics
NPI:1003104597
Name:SELAH GENOMICS INC
Entity Type:Organization
Organization Name:SELAH GENOMICS INC
Other - Org Name:REEDY AQUISITION CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-751-4815
Mailing Address - Street 1:411 UNIVERSITY RDG
Mailing Address - Street 2:NEXT CENTER, SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3762
Mailing Address - Country:US
Mailing Address - Phone:864-751-4815
Mailing Address - Fax:864-751-4825
Practice Address - Street 1:411 UNIVERSITY RDG
Practice Address - Street 2:NEXT CENTER, SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3762
Practice Address - Country:US
Practice Address - Phone:864-751-4815
Practice Address - Fax:864-751-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory