Provider Demographics
NPI:1821196304
Name:PGXHEALTH, LLC
Entity Type:Organization
Organization Name:PGXHEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-452-5400
Mailing Address - Street 1:5 SCIENCE PARK
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1966
Mailing Address - Country:US
Mailing Address - Phone:203-786-3411
Mailing Address - Fax:203-907-1857
Practice Address - Street 1:5 SCIENCE PARK
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1966
Practice Address - Country:US
Practice Address - Phone:203-786-3411
Practice Address - Fax:203-907-1857
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSGENOMIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT07D0995237291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA90976OtherHARVARD PILGRIM
CT070CL0633CT02OtherCT ANTHEM BC/BS
AA90976OtherHARVARD PILGRIM