Healthcare Provider Details

I. General information

NPI: 1437914959
Provider Name (Legal Business Name): FERTILITY GENETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10290 RIDGEGATE CIR
LONE TREE CO
80124-5331
US

IV. Provider business mailing address

10290 RIDGEGATE CIR
LONE TREE CO
80124-5331
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATT TYSON
Title or Position: DIRECTOR, MANAGED CARE CONTRACTING
Credential:
Phone: 615-477-6677