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General NPI Number Information
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NPI Number | 1134559685
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Entity Type | Organization
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Legal Business Name | ADVANTA GENETICS LLC
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 10935 COUNTY ROAD 159
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City | TYLER
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State | TX
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Zip | 75703-3333
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Country | US
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Telephone | 903-805-9955
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Fax | 903-839-2494
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Provider Business Mailing Address
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Address Line | P.O. BOX 3488 DEPT 05-54
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City | TUPELO
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State | MS
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Zip | 38803-3488
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Country | US
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Telephone | 903-805-9955
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Fax | 903-839-2494
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ROBERT E. CARPENTER
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Credential |
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Telephone | 903-805-9955
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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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