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General NPI Number Information
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NPI Number | 1467850859
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Entity Type | Organization
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Legal Business Name | GENOMIND, INC.
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Dates
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Enumeration Date | 12/17/2014
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 2200 RENAISSANCE BLVD SUITE 100
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2755
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Country | US
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Telephone | 877-895-8658
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Fax | 844-364-5850
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Provider Business Mailing Address
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Address Line | 2200 RENAISSANCE BLVD STE 100
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2755
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Country | US
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Telephone | 877-895-8658
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Fax | 844-364-5850
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Authorized Official
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Title or Position | CEO
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Name | MR. SHAWN PATRICK O'BRIEN
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Credential |
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Telephone | 877-895-8658
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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 | 23066
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License Number State | PA
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