Healthcare Provider Details

I. General information

NPI: 1306283569
Provider Name (Legal Business Name): RXGENOMIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 ROBBINS NEST RD
THOMPSONS STATION TN
37179-5387
US

IV. Provider business mailing address

3501 ROBBINS NEST RD
THOMPSONS STATION TN
37179-5387
US

V. Phone/Fax

Practice location:
  • Phone: 615-574-9638
  • Fax:
Mailing address:
  • Phone: 615-574-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY P TICE
Title or Position: PRESIDENT & CEO
Credential: PHARMD, MBA
Phone: 615-574-9638