Organization
GENOMIND, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN PATRICK O'BRIEN (CEO)
(877) 895-8658
Entity
Organization
Contact information
Practice address
2200 RENAISSANCE BLVD, SUITE 100, KING OF PRUSSIA, PA 19406-2755
(877) 895-8658
(844) 364-5850
Mailing address
2200 RENAISSANCE BLVD STE 100, KING OF PRUSSIA, PA 19406-2755
(877) 895-8658
(844) 364-5850
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
23066
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003164790A
—
GA
05
—
100049283
—
WI
05
—
10026540600
—
NE
05
—
1026839
—
VT
05
—
103020171-0001
—
PA
05
—
10670297
—
NM
05
—
137273
—
OH
05
—
13828056
—
DC
05
—
141301500
—
WY
05
—
146193717L00490
—
SC
05
—
1467110
—
ND
05
—
1467850859
—
CA
05
—
1467850859
—
ID
05
—
1467850859
—
ME
05
—
1467850859
—
MI
05
—
1467850859
—
MN
05
—
1467850859
—
NC
05
—
1467850859
—
UT
05
—
1467850859
—
VA
05
—
158836
—
MS
05
—
161953
—
AZ
05
—
1633397
—
AK
05
—
17044500
—
FL
05
—
186566
—
AL
05
—
200146410
—
DE
05
—
200626210A
—
OK
05
—
2011186
—
SD
05
—
201293610A
—
IN
05
—
2049308
—
WA
05
—
215185709
—
AR
01
—
2269
STATE OF MD LABORATORY LICENSE
MD
05
—
2411357
—
LA
05
—
3108879
—
NH
05
—
360077701
—
TX
05
—
3717011-00
—
MD
01
—
39D2088097
CLIA
PA
05
—
426933
—
MT
05
—
499919
—
NJ
05
—
500697689
—
OR
05
—
700023645
—
MO
05
—
707801
—
IA
05
—
7100401540
—
KY
01
—
800027721
STATE OF FL LABORATORY LICENSE
FL
01
—
9035
STATE OF NY LABORATORY LICENSE PFI:
NY
01
—
9046391
CAP CERTIFICATION
—
05
—
93875061
—
CO
01
—
CDS00800594
STATE OF CA LABORATORY LICENSE
CA
05
—
KMAP201122390B
—
KS
01
—
LCO00912
STATE OF RI LABORATORY LICENSE
RI
05
—
Q021455
—
TN
Enumeration date
12/17/2014
Last updated
12/06/2019
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