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General NPI Number Information
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NPI Number | 1215272406
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Entity Type | Organization
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Legal Business Name | GENOTOX LABORATORIES LTD
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2170 WOODWARD SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78744-1074
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Country | US
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Telephone | 512-600-6601
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Fax | 512-600-6602
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Provider Business Mailing Address
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Address Line | 2170 WOODWARD SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78744-1074
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Country | US
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Telephone | 512-600-6601
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Fax | 512-600-6602
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Authorized Official
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Title or Position | CEO
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Name | MATTHEW FREDERICK MCCARTY
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Credential | MD
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Telephone | 512-600-6601
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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 | TX
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Taxonomy #2
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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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