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General NPI Number Information
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NPI Number | 1205205283
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Entity Type | Organization
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Legal Business Name | GENTOX LABORATORIES, LLC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 1811 REES ST SUITE C
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-4239
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Country | US
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Telephone | 337-376-5090
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Fax | 337-376-5051
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Provider Business Mailing Address
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Address Line | 1811 REES ST SUITE C
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-4239
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Country | US
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Telephone | 337-376-5090
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Fax | 337-376-5051
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Authorized Official
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Title or Position | DIRECTOR OF LABORATORIES OPERATIONS
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Name | CHENOA HARDWICK
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Credential |
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Telephone | 972-351-0774
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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 | MD204883
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License Number State | LA
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