Provider Demographics
NPI:1114140571
Name:PREVENTIONGENETICS LLC
Entity Type:Organization
Organization Name:PREVENTIONGENETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-284-5700
Mailing Address - Street 1:3800 S BUSINESS PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-8625
Mailing Address - Country:US
Mailing Address - Phone:715-387-0484
Mailing Address - Fax:715-384-3661
Practice Address - Street 1:3800 S BUSINESS PARK AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-8625
Practice Address - Country:US
Practice Address - Phone:715-387-0484
Practice Address - Fax:715-384-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52D1027685291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory