Provider Demographics
NPI:1477158020
Name:BASE10 GENETICS, LLC
Entity type:Organization
Organization Name:BASE10 GENETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT STRATEGIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:FETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-327-7222
Mailing Address - Street 1:70 E LAKE ST STE 226
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7650
Mailing Address - Country:US
Mailing Address - Phone:866-710-1018
Mailing Address - Fax:
Practice Address - Street 1:70 E LAKE ST STE 226
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7650
Practice Address - Country:US
Practice Address - Phone:866-710-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty