Genetica Diagnostic Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GENETICA DIAGNOSTIC LABORATORY, LLC

Practice address

11720 W Airport Blvd Ste 800
Meadows Place, TX 77477-3062

Phone

(832) 672-6984

NPI assigned

Aug 27, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alejandro Contreras, MD

Title

Medical Director

Phone

(832) 672-6984

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BAS Premier Lab Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535328000000",
    "number": "1700367802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22751 PROFESSIONAL DR STE 210",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773396021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11720 W AIRPORT BLVD STE 800",
            "city": "MEADOWS PLACE",
            "state": "TX",
            "postal_code": "774773062",
            "telephone_number": "832-672-6984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENETICA DIAGNOSTIC LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-27",
        "last_updated": "2018-08-27",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "ALEJANDRO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "832-672-6984",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D2074140",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BAS Premier Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Meadows Place, TX
• Providers in Meadows Place, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.