Provider Demographics
NPI:1982564746
Name:TUSK GENETICS LLC
Entity type:Organization
Organization Name:TUSK GENETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMSC, PA-C
Authorized Official - Phone:435-228-8310
Mailing Address - Street 1:798 S ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-4904
Mailing Address - Country:US
Mailing Address - Phone:435-228-8310
Mailing Address - Fax:
Practice Address - Street 1:798 S ADAMS AVE
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-4904
Practice Address - Country:US
Practice Address - Phone:435-228-8310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty