Provider Demographics
NPI:1134765308
Name:GENE STREET, LLC.
Entity type:Organization
Organization Name:GENE STREET, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-656-9830
Mailing Address - Street 1:11301 FALLBROOK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4269
Mailing Address - Country:US
Mailing Address - Phone:346-656-9830
Mailing Address - Fax:713-703-7916
Practice Address - Street 1:11301 FALLBROOK DR STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4269
Practice Address - Country:US
Practice Address - Phone:346-656-9830
Practice Address - Fax:713-703-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory