Provider Demographics
NPI:1558791517
Name:GNOME DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:GNOME DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-431-6414
Mailing Address - Street 1:1476 MANNING PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7295
Mailing Address - Country:US
Mailing Address - Phone:614-431-6414
Mailing Address - Fax:877-591-1815
Practice Address - Street 1:1476 MANNING PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7295
Practice Address - Country:US
Practice Address - Phone:614-431-6414
Practice Address - Fax:877-591-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2068194291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory