Provider Demographics
NPI:1063792299
Name:SORENSON GENOMICS, LLC
Entity type:Organization
Organization Name:SORENSON GENOMICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-462-1409
Mailing Address - Street 1:2511 S WEST TEMPLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3060
Mailing Address - Country:US
Mailing Address - Phone:801-462-1400
Mailing Address - Fax:801-462-1404
Practice Address - Street 1:2495 S WEST TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-3057
Practice Address - Country:US
Practice Address - Phone:801-462-1400
Practice Address - Fax:801-462-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory