Healthcare Provider Details

I. General information

NPI: 1063044097
Provider Name (Legal Business Name): GENUS3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25319 INTERSTATE 45 STE 102
SPRING TX
77380-3551
US

IV. Provider business mailing address

25319 INTERSTATE 45 STE 102
SPRING TX
77380-3551
US

V. Phone/Fax

Practice location:
  • Phone: 832-603-1086
  • Fax: 866-252-3902
Mailing address:
  • Phone: 832-603-1086
  • Fax: 866-252-3902

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: MR. JERRY JOHNSON
Title or Position: OWNER
Credential:
Phone: 516-590-7089