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Providergenix Llc

NPI Registration Record

Provider / OrganizationNPIDate Certified
PROVIDERGENIX LLC11943270982020-11-15
Other Names:
Entity TypeOrganization
Provider OrganizationPROVIDERGENIX LLC
Practice Office Address3100 E 45TH ST STE 234
CLEVELAND, OH US
Practice Office Telephone4194060067
Practice Office Fax8663093044
Mailing Address3100 E 45TH ST STE 234
CLEVELAND, OH 441271091 US
Business Telephone4194060067
Business Fax8663093044
Authorized OfficialTHOMAS LEE RUSSELL, CEO
4194060067
Offices / Locations
AddressCity / StatePhone / Fax
613 Canyon Dr Lima, OH 458043308 4194060067
HPT Codes
CodeLicense NoState
163W00000X
163WA0400X
163WG0000X
163WH0200X
163WI0500X
163WP0808X
207Q00000X
207R00000X
2084P0800X
2084P0802X
363A00000X
363L00000X
363LP2300X PRIMARY
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
193200000X MULTGroup Code
OPI Codes
Governmental Registrations [CAGE/NCAGE/DUNS]

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