Provider Demographics
NPI:1700591641
Name:CITIZENSDX TEXAS LLC
Entity Type:Organization
Organization Name:CITIZENSDX TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-244-2420
Mailing Address - Street 1:12910 SHELBYVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2404
Mailing Address - Country:US
Mailing Address - Phone:502-244-2420
Mailing Address - Fax:502-996-8282
Practice Address - Street 1:211 E 7TH ST STE 620
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3218
Practice Address - Country:US
Practice Address - Phone:502-244-2451
Practice Address - Fax:502-996-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty