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General NPI Number Information
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NPI Number | 1649506205
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Entity Type | Organization
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Legal Business Name | MOLECULAR DIAGNOSTICS LABORATORIES INC
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 632 RUSSELL ST
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City | COVINGTON
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State | KY
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Zip | 41011-2312
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Country | US
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Telephone | 800-532-2905
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Fax | 859-581-3900
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Provider Business Mailing Address
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Address Line | 632 RUSSELL ST
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City | COVINGTON
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State | KY
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Zip | 41011-2312
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Country | US
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Telephone | 800-532-2905
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Fax | 859-581-3900
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK GENBAUFFE
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Credential | PHD
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Telephone | 800-532-2905
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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 | 18D1100471
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License Number State | KY
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