Provider Demographics
NPI:1497223473
Name:X-GENE MOLECULAR LABORATORIES, INC
Entity Type:Organization
Organization Name:X-GENE MOLECULAR LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL-CONTRACT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:TAMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-962-7894
Mailing Address - Street 1:7145 E VIRGINIA ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9147
Mailing Address - Country:US
Mailing Address - Phone:812-962-7894
Mailing Address - Fax:
Practice Address - Street 1:4205 SPRINGHURST BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6159
Practice Address - Country:US
Practice Address - Phone:859-361-8704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18D2157664OtherCLIA
KY200396OtherMEDICAL LABORATORY LICENSE