Provider Demographics
NPI:1780203638
Name:TRANSLATIONAL GENOMICS RESEARCH INSTITUTE
Entity Type:Organization
Organization Name:TRANSLATIONAL GENOMICS RESEARCH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:OZOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-343-8623
Mailing Address - Street 1:3051 W SHAMRELL BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-9435
Mailing Address - Country:US
Mailing Address - Phone:928-226-6370
Mailing Address - Fax:
Practice Address - Street 1:3051 W SHAMRELL BLVD STE 106
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86005-9435
Practice Address - Country:US
Practice Address - Phone:928-226-6370
Practice Address - Fax:978-528-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03D2180037OtherCLIA