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Organization

GENESIS MEDICAL DIAGNOSTICS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EWAN D. JOHNSON MD, PHD (CEO/FOUNDER)
(281) 415-6687
Entity
Organization

Contact information

Practice address
9359 INTERSTATE 37 STE D, CORPUS CHRISTI, TX 78409-3200
(361) 248-4062
(832) 565-1921
Mailing address
14090 FM 2920 RD STE 345G, TOMBALL, TX 77377-5549
(281) 415-6687

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
45D2199395
CLIA NUMBER-CORPUS CHRISTI LOCATION
TX
01
45D2216579
CLIA NUMBER-LAREDO LOCATION
TX
01
45D2216609
CLIA NUMBER- SAN ANTONIO LOCATION
TX
Enumeration date
08/17/2021
Last updated
09/16/2021
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