Provider Demographics
NPI:1073776860
Name:MICROGENDX, LLC
Entity type:Organization
Organization Name:MICROGENDX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-776-2611
Mailing Address - Street 1:5776 HOFFNER AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4810
Mailing Address - Country:US
Mailing Address - Phone:806-776-2611
Mailing Address - Fax:806-749-7886
Practice Address - Street 1:6901 QUAKER AVE STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5940
Practice Address - Country:US
Practice Address - Phone:806-776-2611
Practice Address - Fax:806-749-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL1026Medicare PIN