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General NPI Number Information
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NPI Number | 1700023181
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Entity Type | Organization
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Legal Business Name | TISSUE GENETICS, INC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 12635 E MONTVIEW BLVD STE 133
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City | AURORA
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State | CO
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Zip | 80045-7335
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Country | US
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Telephone | 720-859-4053
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Fax | 720-859-4110
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Provider Business Mailing Address
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Address Line | 12635 E MONTVIEW BLVD STE 133
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City | AURORA
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State | CO
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Zip | 80045-7335
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Country | US
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Telephone | 720-859-4053
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Fax | 720-859-4110
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Authorized Official
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Title or Position | PRESIDENT CHIEF SCIENCE OFFICER
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Name | DR. JEFFREY THOMAS HOLT
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Credential | MD
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Telephone | 720-859-4053
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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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