Progenitor MDX, Inc

Primary specialty

Clinical Laboratory Director (Non-physician)Taxonomy code 247ZC0005X

Legal business name

PROGENITOR MDX, INC

Practice address

675 S Arapeen Dr # 103B
Salt Lake City, UT 84108-1223

Phone

(877) 502-4748

NPI assigned

Dec 24, 2020

Organization subpart

No

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

Authorized official

Name

Gary R Sams, PHD

Title

Physician

Phone

(877) 502-4748

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1608768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609891200000",
    "number": "1841887833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 S ARAPEEN DR # 103B",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081223",
            "telephone_number": "877-502-4748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 S ARAPEEN DR # 103B",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081223",
            "telephone_number": "877-502-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGENITOR MDX, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-24",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A",
        "authorized_official_last_name": "SAMS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "877-502-4748",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "247ZC0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Laboratory Director (Non-physician) in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Laboratory Director (Non-physician) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; 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.