Advanta Genetics LLC
Organization Active NPI Clinical Medical Laboratory · Tyler, TX
NPI 1134559685 · NPPES record last updated Apr 29, 2026
Key facts
- NPI
- 1134559685
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- ADVANTA GENETICS LLC
- Practice address
- 10935 County Road 159
Tyler, TX 75703-3333 - Phone
- (903) 805-9955
- Fax
- (903) 839-2494
- NPI assigned
- Nov 20, 2013
- Organization subpart
- No
Authorized official
- Name
- Charles Guilbault
- Title
- Ceo
- Phone
- (903) 805-9955
Member of 1
Practitioners 1
-
Randall W Rodgers, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140718000631 | TX | Part B Supplier - Independent Clinical Laboratory | 4981820495 | Practice locations: Tyler, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
10935 County Road 159
Tyler, TX 75703-3333
Mailing address
10935 County Road 159
Tyler, TX 75703-3333
Phone (903) 805-9955
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45D2063134 | Other | TX | CLIA NUMBER |
| 8863194 | Other | TX | CAP |
Other names
- ADVANTA ANALYTICAL LABORATORIES
- ADVANTA TOXICOLOGY LLC
Other providers in Tyler, TX
- Rebecca Adricula
- Adult Counseling and Resources, PLLC
- Advanced Eyecare
- Advanced Health Center PLLC
- Advanced Wellness
- Afaha M Asangansi
- Afaha M. Asangansi ; Zaria Medical Equipment & Supplies
- Affect Provider Group, P.S.C.
- Affordable Dentist Near Me Tyler
- Affordable Dentures & Implants - Texas III, PLLC
All providers in Tyler, TX · Clinical Medical Laboratory in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.