1467850859 NPI number — GENOMIND, INC.

Table of content: (NPI 1467850859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467850859 NPI number — GENOMIND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENOMIND, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467850859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 RENAISSANCE BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-2755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-895-8658
Provider Business Mailing Address Fax Number:
844-364-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 RENAISSANCE BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-2755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-895-8658
Provider Business Practice Location Address Fax Number:
844-364-5850
Provider Enumeration Date:
12/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
O'BRIEN
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
877-895-8658

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  23066 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1467850859 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467850859 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161953 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2269 . This is a "STATE OF MD LABORATORY LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 360077701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CDS00800594 . This is a "STATE OF CA LABORATORY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: KMAP201122390B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13828056 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467850859 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2049308 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700023645 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026540600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137273 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467850859 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467850859 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467850859 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158836 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 215185709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103020171-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17044500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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