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General NPI Number Information
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NPI Number | 1639957897
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Entity Type | Organization
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Legal Business Name | GENESIS REFERENCE LABORATORIES, LLC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 6547 S RACINE CIR STE 1100
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City | CENTENNIAL
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State | CO
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Zip | 80111-6456
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Country | US
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Telephone | 407-232-7172
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Fax |
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Provider Business Mailing Address
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Address Line | 7924 FOREST CITY RD STE 210
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City | ORLANDO
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State | FL
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Zip | 32810-2925
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Country | US
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Telephone | 407-232-7172
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Fax | 407-289-4082
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | PHILIP DAVID FREITAS
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Credential |
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Telephone | 407-232-7172
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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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