Provider Demographics
NPI:1114772902
Name:REVEAL GENOMICS USA INC.
Entity type:Organization
Organization Name:REVEAL GENOMICS USA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, MARKET ACCESS
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:773-569-0628
Mailing Address - Street 1:150 N RESEARCH CAMPUS DR.
Mailing Address - Street 2:OFFICE 4320, SUITE 4314
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081
Mailing Address - Country:US
Mailing Address - Phone:704-250-2690
Mailing Address - Fax:212-947-6246
Practice Address - Street 1:150 N RESEARCH CAMPUS DR.
Practice Address - Street 2:OFFICE 4320, SUITE 4314
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081
Practice Address - Country:US
Practice Address - Phone:704-250-2690
Practice Address - Fax:212-947-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory