Provider Demographics
NPI:1588229041
Name:PREDICTIVE LABORATORIES, INC.
Entity Type:Organization
Organization Name:PREDICTIVE LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-290-4504
Mailing Address - Street 1:2735 E PARLEYS WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1631
Mailing Address - Country:US
Mailing Address - Phone:855-497-3636
Mailing Address - Fax:888-972-9124
Practice Address - Street 1:2749 E PARLEYS WAY STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1638
Practice Address - Country:US
Practice Address - Phone:855-497-3636
Practice Address - Fax:888-972-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular GeneticsGroup - Multi-Specialty