Provider Demographics
NPI:1821670704
Name:GENEPACE LABORATORIES, LLC.
Entity Type:Organization
Organization Name:GENEPACE LABORATORIES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SCIENTIFIC OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MULAMOOTTIL
Authorized Official - Middle Name:PAPPY
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-848-2995
Mailing Address - Street 1:1210 WATERWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2167
Mailing Address - Country:US
Mailing Address - Phone:847-848-2995
Mailing Address - Fax:
Practice Address - Street 1:1210 WATERWAY BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2167
Practice Address - Country:US
Practice Address - Phone:847-848-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory