Provider Demographics
NPI:1689120354
Name:ADVANCED BIOGENETICS AND LIFE SCIENCES, LLC
Entity Type:Organization
Organization Name:ADVANCED BIOGENETICS AND LIFE SCIENCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:806-395-1001
Mailing Address - Street 1:112 ELSIE
Mailing Address - Street 2:PO 145
Mailing Address - City:PANHANDLE
Mailing Address - State:TX
Mailing Address - Zip Code:79068-0145
Mailing Address - Country:US
Mailing Address - Phone:806-395-1001
Mailing Address - Fax:
Practice Address - Street 1:112 ELSIE
Practice Address - Street 2:PO 145
Practice Address - City:PANHANDLE
Practice Address - State:TX
Practice Address - Zip Code:79068-0145
Practice Address - Country:US
Practice Address - Phone:806-395-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74185251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health