Provider Demographics
NPI:1215003603
Name:GENOMIC HEALTH, INC.
Entity Type:Organization
Organization Name:GENOMIC HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-284-5700
Mailing Address - Street 1:PO BOX 735265
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5265
Mailing Address - Country:US
Mailing Address - Phone:866-662-6897
Mailing Address - Fax:866-383-1932
Practice Address - Street 1:301 PENOBSCOT DRIVE
Practice Address - Street 2:BILLING AND REIMBURSEMENT OPS.
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-4700
Practice Address - Country:US
Practice Address - Phone:866-662-6897
Practice Address - Fax:866-383-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
CACLF11799291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB18272FMedicaid
05D1018272OtherCLA
CALAB18272FMedicaid
CA05D2110785OtherCLIA
AUID1421699OtherCAP COLLEGE OF AMERICAN
CACDF00011799OtherCA DEPARTMENT OF PUBLIC HEALTH
CACLF 00349285OtherSTATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH