Provider Demographics
NPI:1144308479
Name:GENETICS OF MEMPHIS, INC
Entity type:Organization
Organization Name:GENETICS OF MEMPHIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:S.
Authorized Official - Middle Name:A
Authorized Official - Last Name:THARAPEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-685-0333
Mailing Address - Street 1:1770 MORIAH WOODS BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7126
Mailing Address - Country:US
Mailing Address - Phone:901-685-0333
Mailing Address - Fax:901-448-6676
Practice Address - Street 1:1770 MORIAH WOODS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7126
Practice Address - Country:US
Practice Address - Phone:901-685-0333
Practice Address - Fax:901-683-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004047291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05587754Medicaid
P00245199Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3404235Medicare ID - Type UnspecifiedPROVIDER NUMBER