Provider Demographics
NPI:1508268731
Name:MEDCOMP GX, LLC
Entity Type:Organization
Organization Name:MEDCOMP GX, LLC
Other - Org Name:APOLLO GENETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-694-4842
Mailing Address - Street 1:1111 E DRAPER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9058
Mailing Address - Country:US
Mailing Address - Phone:801-916-1837
Mailing Address - Fax:
Practice Address - Street 1:1799 STUMPF BLVD.
Practice Address - Street 2:BLDG. 2, SUITES 1 & 2
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2200
Practice Address - Country:US
Practice Address - Phone:883-757-0751
Practice Address - Fax:833-850-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory