Provider Demographics
NPI:1306652037
Name:GENOSCREEN LAB LLC
Entity type:Organization
Organization Name:GENOSCREEN LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-821-6633
Mailing Address - Street 1:6127 S UNIVERSITY AVE STE 1274
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-7505
Mailing Address - Country:US
Mailing Address - Phone:773-782-6355
Mailing Address - Fax:773-782-6322
Practice Address - Street 1:6127 S UNIVERSITY AVE STE 1274
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-7505
Practice Address - Country:US
Practice Address - Phone:773-782-6355
Practice Address - Fax:773-782-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory