Provider Demographics
NPI:1376206425
Name:INFINITE GENOMICS LLC
Entity type:Organization
Organization Name:INFINITE GENOMICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-798-7100
Mailing Address - Street 1:4850 NORTHSHORE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5329
Mailing Address - Country:US
Mailing Address - Phone:501-798-7100
Mailing Address - Fax:501-798-7101
Practice Address - Street 1:4850 NORTHSHORE LN
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5329
Practice Address - Country:US
Practice Address - Phone:501-798-7100
Practice Address - Fax:501-798-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY213897200Medicaid
AL322000Medicaid
KY7100983310Medicaid
CO9000203807Medicaid
OH0477871Medicaid
MO700109508Medicaid
WA2276860Medicaid
KS30004802830001Medicaid
NM89405889Medicaid
WI1376206425Medicaid
AR290638709Medicaid