GENOMIND, INC.

Provider Demographics

• NPI: 1467850859
• Name: GENOMIND, INC.
• Entity type: Organization
• Organization Name: GENOMIND, INC.
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: SHAWN
• Authorized Official - Middle Name: PATRICK
• Authorized Official - Last Name: O'BRIEN
• Authorized Official - Phone: 877-895-8658
• Mailing Address - Street 1: 2200 RENAISSANCE BLVD STE 100
• Mailing Address - City: KING OF PRUSSIA
• Mailing Address - State: PA
• Mailing Address - Zip Code: 19406-2755
• Mailing Address - Country: US
• Mailing Address - Phone: 877-895-8658
• Mailing Address - Fax: 844-364-5850
• Practice Address - Street 1: 2200 RENAISSANCE BLVD
• Practice Address - Street 2: SUITE 100
• Practice Address - City: KING OF PRUSSIA
• Practice Address - State: PA
• Practice Address - Zip Code: 19406-2755
• Practice Address - Country: US
• Practice Address - Phone: 877-895-8658
• Practice Address - Fax: 844-364-5850
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2014-12-17
• Last Update Date: 2019-12-06

Provider Licenses

State	License ID	Taxonomies
PA	23066	291U00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	291U00000X	Laboratories	Clinical Medical Laboratory

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	1467850859	Medicaid
ME	1467850859	Medicaid
AZ	161953	Medicaid
MD	2269	Other	STATE OF MD LABORATORY LICENSE
TX	360077701	Medicaid
CA	CDS00800594	Other	STATE OF CA LABORATORY LICENSE
KS	KMAP201122390B	Medicaid
DC	13828056	Medicaid
MI	1467850859	Medicaid
WA	2049308	Medicaid
MO	700023645	Medicaid
NE	10026540600	Medicaid
OH	137273	Medicaid
VA	1467850859	Medicaid
MN	1467850859	Medicaid
ID	1467850859	Medicaid
MS	158836	Medicaid
AR	215185709	Medicaid
PA	103020171-0001	Medicaid
FL	17044500	Medicaid
AL	186566	Medicaid
NH	3108879	Medicaid
MD	3717011-00	Medicaid
NY	9035	Other	STATE OF NY LABORATORY LICENSE PFI:
	9046391	Other	CAP CERTIFICATION
CO	93875061	Medicaid
WI	100049283	Medicaid
VT	1026839	Medicaid
NM	10670297	Medicaid
PA	39D2088097	Other	CLIA
OR	500697689	Medicaid
DE	200146410	Medicaid
SD	2011186	Medicaid
IN	201293610A	Medicaid
IA	707801	Medicaid
KY	7100401540	Medicaid
RI	LCO00912	Other	STATE OF RI LABORATORY LICENSE
GA	003164790A	Medicaid
WY	141301500	Medicaid
UT	1467850859	Medicaid
AK	1633397	Medicaid
OK	200626210A	Medicaid
MT	426933	Medicaid
TN	Q021455	Medicaid
SC	146193717L00490	Medicaid
ND	1467110	Medicaid
NC	1467850859	Medicaid
LA	2411357	Medicaid
NJ	499919	Medicaid
FL	800027721	Other	STATE OF FL LABORATORY LICENSE