Provider Demographics
NPI:1467783753
Name:MATRIX GENOMICS, INC.
Entity Type:Organization
Organization Name:MATRIX GENOMICS, INC.
Other - Org Name:MATRIX GENOMICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:CORDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-216-0660
Mailing Address - Street 1:3900 PASEO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4072
Mailing Address - Country:US
Mailing Address - Phone:505-216-0660
Mailing Address - Fax:505-216-1144
Practice Address - Street 1:3900 PASEO DEL SOL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4072
Practice Address - Country:US
Practice Address - Phone:505-216-0660
Practice Address - Fax:505-216-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory