Provider Demographics
NPI:1972845527
Name:AMERIGENE PGT, LLC
Entity Type:Organization
Organization Name:AMERIGENE PGT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-699-1632
Mailing Address - Street 1:7707 FANNIN ST
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1926
Mailing Address - Country:US
Mailing Address - Phone:205-699-1632
Mailing Address - Fax:866-546-2124
Practice Address - Street 1:7707 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1926
Practice Address - Country:US
Practice Address - Phone:205-699-1632
Practice Address - Fax:866-546-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D054300291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory