Provider Demographics
NPI:1225729312
Name:GENE MATRIX LLC
Entity Type:Organization
Organization Name:GENE MATRIX LLC
Other - Org Name:GENE MATRIX PGX DNA TESTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SASO
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-302-9668
Mailing Address - Street 1:1046 W KINZIE ST STE 100E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6508
Mailing Address - Country:US
Mailing Address - Phone:847-302-9668
Mailing Address - Fax:
Practice Address - Street 1:1046 W KINZIE ST STE 100E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6508
Practice Address - Country:US
Practice Address - Phone:847-302-9668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory