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General NPI Number Information
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NPI Number | 1003104597
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Entity Type | Organization
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Legal Business Name | SELAH GENOMICS INC
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 411 UNIVERSITY RDG NEXT CENTER, SUITE A
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City | GREENVILLE
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State | SC
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Zip | 29601-3762
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Country | US
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Telephone | 864-751-4815
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Fax | 864-751-4825
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Provider Business Mailing Address
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Address Line | 411 UNIVERSITY RDG NEXT CENTER, SUITE A
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City | GREENVILLE
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State | SC
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Zip | 29601-3762
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Country | US
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Telephone | 864-751-4815
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Fax | 864-751-4825
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL BOLICK
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Credential |
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Telephone | 864-751-4815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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