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
2329 JACAMAN RD STE 10, LAREDO, TX 78041-6264
(956) 516-5978
(832) 565-1921
Mailing address
14090 FM 2920 RD STE 345G, TOMBALL, TX 77377-5549
(281) 415-6687
(832) 565-1921
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2216579
CLIA NUMBER
TX
Enumeration date
07/23/2021
Last updated
09/16/2021
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