Provider Demographics
NPI:1295140655
Name:GENETICHUB
Entity type:Organization
Organization Name:GENETICHUB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:CLYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-434-1001
Mailing Address - Street 1:509 S WALL AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2523
Mailing Address - Country:US
Mailing Address - Phone:888-696-3352
Mailing Address - Fax:650-434-3984
Practice Address - Street 1:509 S WALL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2523
Practice Address - Country:US
Practice Address - Phone:888-696-3352
Practice Address - Fax:650-434-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage