Provider Demographics
NPI:1013101526
Name:NUTRI GENOMICS INC
Entity Type:Organization
Organization Name:NUTRI GENOMICS INC
Other - Org Name:CARE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-306-1920
Mailing Address - Street 1:4201 BEE CAVES RD
Mailing Address - Street 2:SUITE B200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-306-1920
Mailing Address - Fax:512-306-9233
Practice Address - Street 1:4201 BEE CAVES RD
Practice Address - Street 2:SUITE B200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-306-1920
Practice Address - Fax:512-306-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory