Provider Demographics
NPI:1356810675
Name:GENETICS PROVIDERS LLC
Entity type:Organization
Organization Name:GENETICS PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CHILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-858-1082
Mailing Address - Street 1:15821 VENTURA BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4793
Mailing Address - Country:US
Mailing Address - Phone:818-858-1080
Mailing Address - Fax:323-729-3933
Practice Address - Street 1:125 COOL SPRINGS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6475
Practice Address - Country:US
Practice Address - Phone:833-700-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FPG LABS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics