Provider Demographics
NPI:1215216759
Name:INVITAE CORPORATION
Entity Type:Organization
Organization Name:INVITAE CORPORATION
Other - Org Name:INVITAE CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-436-3037
Mailing Address - Street 1:1400 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-5110
Mailing Address - Country:US
Mailing Address - Phone:800-436-3037
Mailing Address - Fax:415-276-4164
Practice Address - Street 1:1001 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8935
Practice Address - Country:US
Practice Address - Phone:800-436-3037
Practice Address - Fax:415-276-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 291U00000X
MA22D2025627291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAATN111681Medicaid