Provider Demographics
NPI:1245427673
Name:REPRODUCTIVE GENETICS CENTER, PC
Entity Type:Organization
Organization Name:REPRODUCTIVE GENETICS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-399-5393
Mailing Address - Street 1:455 S HUDSON ST
Mailing Address - Street 2:LEVEL 3
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1479
Mailing Address - Country:US
Mailing Address - Phone:303-399-5393
Mailing Address - Fax:303-399-9160
Practice Address - Street 1:455 S HUDSON ST
Practice Address - Street 2:LEVEL 3
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1479
Practice Address - Country:US
Practice Address - Phone:303-399-5393
Practice Address - Fax:303-399-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16829207SG0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08000846Medicaid
CO08000846Medicaid