Provider Demographics
NPI:1114222817
Name:PROGENITY INC.
Entity Type:Organization
Organization Name:PROGENITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-293-2639
Mailing Address - Street 1:5230 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-7936
Mailing Address - Country:US
Mailing Address - Phone:855-293-2639
Mailing Address - Fax:248-848-1623
Practice Address - Street 1:5230 S STATE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-7936
Practice Address - Country:US
Practice Address - Phone:855-293-2639
Practice Address - Fax:248-848-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23 D 2018899OtherCLIA
MI7534637-01OtherCAP