Provider Demographics
NPI:1023433281
Name:IGENOMIX USA LLC
Entity type:Organization
Organization Name:IGENOMIX USA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARTESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-959-3968
Mailing Address - Street 1:7955 NW 12TH ST STE 415
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1823
Mailing Address - Country:US
Mailing Address - Phone:305-501-4948
Mailing Address - Fax:786-401-7546
Practice Address - Street 1:7955 NW 12TH ST STE 415
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1823
Practice Address - Country:US
Practice Address - Phone:305-501-4948
Practice Address - Fax:786-401-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800027055291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory