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General NPI Number Information
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NPI Number | 1962655811
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Entity Type | Organization
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Legal Business Name | GENETIC DIAGNOSTICS
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 6000 HARRY HINES BLVD HAMON BLDG, ROOM NA2 508A
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City | DALLAS
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State | TX
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Zip | 75390-0001
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Country | US
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Telephone | 214-645-0624
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 845347
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City | DALLAS
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State | TX
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Zip | 75284-5347
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Country | US
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Telephone | 214-645-0624
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | BRUCE FAIRBANKS
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Credential |
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Telephone | 214-648-0309
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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 | 45D1089001
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License Number State | TX
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