MEDICARE: PGXHEALTH, 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		NC

General Provider Information

NPI Number	:	1841399771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PGXHEALTH, LLC

Provider Business Mailing Address
First Line	:	100 PERIMETER PARK DR
Second Line	:	SUITE C
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-9715
Country	:	US
Telephone Number	:	919-468-8890
Fax Number	:	919-468-8766

Provider Business Practice Location Address
First Line	:	100 PERIMETER PARK DR
Second Line	:	SUITE C
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-9715
Country	:	US
Telephone Number	:	919-468-8890
Fax Number	:	919-468-8766

Authorized Official
Title or Position	:	EXECUTIVE V.P.
Name	:	MR. CAESAR BELBEL
Credential	:
Telephone Number	:	617-527-9933

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/19/2007

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