Provider Demographics
NPI:1629713748
Name:NVIRA GENETICS LLC
Entity Type:Organization
Organization Name:NVIRA GENETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSAITEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-705-9900
Mailing Address - Street 1:2510 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-4316
Mailing Address - Country:US
Mailing Address - Phone:262-622-6260
Mailing Address - Fax:
Practice Address - Street 1:2510 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-4316
Practice Address - Country:US
Practice Address - Phone:262-705-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory