MEDICARE: MICROGENDX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1073776860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICROGENDX, LLC

Provider Business Mailing Address
First Line	:	5776 HOFFNER AVE STE 203
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4810
Country	:	US
Telephone Number	:	806-776-2611
Fax Number	:	806-749-7886

Provider Business Practice Location Address
First Line	:	6901 QUAKER AVE STE 200
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79413-5940
Country	:	US
Telephone Number	:	806-776-2611
Fax Number	:	806-749-7886

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	SHANLEY COLLINS
Credential	:
Telephone Number	:	806-776-2611

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	03/26/2025

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Directions to “MICROGENDX, LLC ” Practice Location

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