Provider Demographics
NPI:1275913642
Name:GENOMIC HEALTH INC.
Entity Type:Organization
Organization Name:GENOMIC HEALTH INC.
Other - Org Name:ASHION
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-284-5700
Mailing Address - Street 1:PO BOX 742415
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2415
Mailing Address - Country:US
Mailing Address - Phone:866-662-6897
Mailing Address - Fax:866-383-1932
Practice Address - Street 1:445 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2157
Practice Address - Country:US
Practice Address - Phone:844-539-3309
Practice Address - Fax:602-343-8440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENOMIC HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-01
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D2048606291U00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ002671Medicaid