Provider Demographics
NPI:1841998606
Name:CORGENIX
Entity type:Organization
Organization Name:CORGENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-457-4345
Mailing Address - Street 1:11575 MAIN ST UNIT 400
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2782
Mailing Address - Country:US
Mailing Address - Phone:303-457-4345
Mailing Address - Fax:303-457-4519
Practice Address - Street 1:11575 MAIN ST UNIT 400
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2782
Practice Address - Country:US
Practice Address - Phone:303-457-4345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06D2146482OtherCLIA LICENSE
CO8323392OtherCAP