Provider Demographics
NPI:1427479864
Name:IMPACT GENETICS INC.
Entity type:Organization
Organization Name:IMPACT GENETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:647-478-4902
Mailing Address - Street 1:1100 BENNETT ROAD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:BOWMANVILLE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L1C 3K5
Mailing Address - Country:CA
Mailing Address - Phone:647-478-4902
Mailing Address - Fax:905-679-9786
Practice Address - Street 1:1100 BENNETT ROAD
Practice Address - Street 2:UNIT 4
Practice Address - City:BOWMANVILLE
Practice Address - State:ONTARIO
Practice Address - Zip Code:L1C 3K5
Practice Address - Country:CA
Practice Address - Phone:647-478-4902
Practice Address - Fax:905-679-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZCLIA 99D990947291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory