Provider Demographics
NPI:1760904361
Name:ACGT, INC.
Entity Type:Organization
Organization Name:ACGT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:847-520-9162
Mailing Address - Street 1:35 W WALTZ DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6052
Mailing Address - Country:US
Mailing Address - Phone:847-520-9162
Mailing Address - Fax:847-520-9163
Practice Address - Street 1:35 W WALTZ DR
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-6052
Practice Address - Country:US
Practice Address - Phone:847-520-9162
Practice Address - Fax:847-520-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No291U00000XLaboratoriesClinical Medical Laboratory