Healthcare Provider Details

I. General information

NPI: 1497223473
Provider Name (Legal Business Name): X-GENE MOLECULAR LABORATORIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 SPRINGHURST BLVD STE 101A
LOUISVILLE KY
40241-6159
US

IV. Provider business mailing address

7145 E VIRGINIA ST STE 2000
EVANSVILLE IN
47715-9147
US

V. Phone/Fax

Practice location:
  • Phone: 859-361-8704
  • Fax:
Mailing address:
  • Phone: 812-962-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMIA FISHER
Title or Position: CREDENTIAL-CONTRACT ANALYST
Credential:
Phone: 812-962-7894