Provider Demographics
NPI:1265458921
Name:ACCESS GENETICS, LLC
Entity Type:Organization
Organization Name:ACCESS GENETICS, LLC
Other - Org Name:ORALDNA LABS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MCGLENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-400-7785
Mailing Address - Street 1:PO BOX 1414
Mailing Address - Street 2:MI63
Mailing Address - City:MINNEAPLOIS
Mailing Address - State:MN
Mailing Address - Zip Code:55480-1414
Mailing Address - Country:US
Mailing Address - Phone:888-250-4407
Mailing Address - Fax:952-767-1153
Practice Address - Street 1:7400 FLYING CLOUD DR
Practice Address - Street 2:SUITE 150
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3720
Practice Address - Country:US
Practice Address - Phone:888-250-4407
Practice Address - Fax:952-942-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24D1033809291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN897100000Medicaid
MN897100000Medicaid