Provider Demographics
NPI:1649394917
Name:KIMBALL GENETICS, INC.
Entity Type:Organization
Organization Name:KIMBALL GENETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PHD
Authorized Official - Phone:303-320-1807
Mailing Address - Street 1:650 S CHERRY ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1801
Mailing Address - Country:US
Mailing Address - Phone:303-320-1807
Mailing Address - Fax:303-388-9220
Practice Address - Street 1:650 S CHERRY ST
Practice Address - Street 2:SUITE 225
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1801
Practice Address - Country:US
Practice Address - Phone:303-320-1807
Practice Address - Fax:303-388-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805613400Medicaid
WY1111361 00Medicaid
FL030939700Medicaid
GA731970238AMedicaid
PA101429170 0001Medicaid
NM00070977Medicaid
AL009919290Medicaid
CO08002362Medicaid
CO08002362Medicaid
ID805613400Medicaid