Provider Demographics
NPI:1700023181
Name:TISSUE GENETICS, INC
Entity Type:Organization
Organization Name:TISSUE GENETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIEF SCIENCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-859-4053
Mailing Address - Street 1:12635 E MONTVIEW BLVD
Mailing Address - Street 2:STE 133
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7335
Mailing Address - Country:US
Mailing Address - Phone:720-859-4053
Mailing Address - Fax:720-859-4110
Practice Address - Street 1:12635 E MONTVIEW BLVD
Practice Address - Street 2:STE 133
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7335
Practice Address - Country:US
Practice Address - Phone:720-859-4053
Practice Address - Fax:720-859-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory