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General NPI Number Information
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NPI Number | 1518406636
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Entity Type | Organization
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Legal Business Name | GENTECH LABORATORIES LLC
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 4403 N BELTWOOD PKWY STE 100
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City | DALLAS
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State | TX
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Zip | 75244-3216
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Country | US
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Telephone | 214-797-6734
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Fax | 972-499-9199
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Provider Business Mailing Address
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Address Line | 1801 W OLYMPIC BLVD FILE 2634
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City | PASADENA
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State | CA
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Zip | 91199
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Country | US
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Telephone | 214-797-6734
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Fax | 972-499-9199
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Authorized Official
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Title or Position | CEO
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Name | VINCE THAYER
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Credential |
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Telephone | 214-797-6734
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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 | 45D2100263
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License Number State | TX
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