Provider Demographics
NPI:1649506205
Name:MOLECULAR DIAGNOSTICS LABORATORIES INC
Entity type:Organization
Organization Name:MOLECULAR DIAGNOSTICS LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GENBAUFFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:800-532-2905
Mailing Address - Street 1:632 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2312
Mailing Address - Country:US
Mailing Address - Phone:800-532-2905
Mailing Address - Fax:859-581-3900
Practice Address - Street 1:632 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2312
Practice Address - Country:US
Practice Address - Phone:800-532-2905
Practice Address - Fax:859-581-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18D1100471291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory