Provider Demographics
NPI:1356863302
Name:GENESIS GENETICS TEXAS
Entity Type:Organization
Organization Name:GENESIS GENETICS TEXAS
Other - Org Name:GENESIS GENETICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-601-9808
Mailing Address - Street 1:75 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611
Mailing Address - Country:US
Mailing Address - Phone:203-601-5200
Mailing Address - Fax:
Practice Address - Street 1:1120 BINZ STREET
Practice Address - Street 2:SUITE 1180
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-6900
Practice Address - Country:US
Practice Address - Phone:313-579-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER GENOMICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory