Provider Demographics
NPI:1063373298
Name:GENNEXTIC LLC
Entity type:Organization
Organization Name:GENNEXTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LAB TEC, MEDICAL ASS
Authorized Official - Phone:804-429-7818
Mailing Address - Street 1:4108 W HUNDRED RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1731
Mailing Address - Country:US
Mailing Address - Phone:804-429-7818
Mailing Address - Fax:804-429-7818
Practice Address - Street 1:4108 W HUNDRED RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1731
Practice Address - Country:US
Practice Address - Phone:804-429-7818
Practice Address - Fax:804-429-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory