Provider Demographics
NPI:1740726983
Name:PRINCIPLE GENETICS LLC
Entity type:Organization
Organization Name:PRINCIPLE GENETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-549-8355
Mailing Address - Street 1:16840 BUCCANEER LN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2507
Mailing Address - Country:US
Mailing Address - Phone:832-549-8355
Mailing Address - Fax:
Practice Address - Street 1:16840 BUCCANEER LN
Practice Address - Street 2:SUITE 5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2507
Practice Address - Country:US
Practice Address - Phone:832-549-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2123176291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory