Organization
PHARMACOGENETICS DIAGNOSTIC LABORATORY LLC
Active
Other names
PGXL Laboratories
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LINDER PHD (VP)
(502) 569-1584
Entity
Organization
Contact information
Practice address
201 E JEFFERSON ST, SUITE 309, LOUISVILLE, KY 40202-1246
(502) 569-1584
(502) 569-1585
Mailing address
201 E JEFFERSON ST, SUITE 309, LOUISVILLE, KY 40202-1246
(502) 569-1584
(502) 569-1054
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
200251
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000531561
ANTHEM BLUE CROSS
KY
05
—
00026220
—
MS
05
—
003132163A
—
GA
05
—
0065657
—
OH
05
—
0110438
—
IA
05
—
0380351
—
NJ
05
—
06555519
—
NM
05
—
100262578-00
—
NE
05
—
102795040 0001
—
PA
05
—
1255376620
—
AL
05
—
1255376620
—
ID
05
—
1255376620
—
ME
05
—
1255376620
—
MO
05
—
1255376620
—
MT
05
—
1255376620
—
UT
05
—
1255376620
—
VA
05
—
1255376620
—
WA
05
—
1530585
—
TN
05
—
1582673
—
AK
05
—
195993709
—
AR
05
—
200970280A
—
KS
05
—
201093810A
—
IN
05
—
2338391
—
LA
05
—
2659764
—
MI
05
—
3810025173
—
WV
05
—
4215397 00
—
MD
05
—
500652629
—
OR
05
—
50121715
—
CO
05
—
7001484
—
NC
05
—
738908
—
HI
05
—
7405899
—
KY
05
—
808295
—
AZ
05
—
L00368
—
SC
05
—
TIN-001
—
IL
Enumeration date
06/18/2006
Last updated
05/07/2015
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