MEDICARE: CLARITY GENETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598117186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARITY GENETICS LLC

Provider Business Mailing Address
First Line	:	801 BROADWAY AVE NW STE 203
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-4463
Country	:	US
Telephone Number	:	855-776-9436
Fax Number	:

Provider Business Practice Location Address
First Line	:	5231 NW 33RD AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-6302
Country	:	US
Telephone Number	:	855-776-9436
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALAN MACK
Credential	:
Telephone Number	:	855-776-9436

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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Directions to “CLARITY GENETICS LLC ” Practice Location

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