Provider Demographics
NPI:1881075497
Name:TRANSPLANT GENOMICS, INC.
Entity type:Organization
Organization Name:TRANSPLANT GENOMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:URBANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-554-5111
Mailing Address - Street 1:46774 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6529
Mailing Address - Country:US
Mailing Address - Phone:844-878-4723
Mailing Address - Fax:888-224-3499
Practice Address - Street 1:46774 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-6529
Practice Address - Country:US
Practice Address - Phone:844-878-4723
Practice Address - Fax:888-224-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00347776291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory