Organization
CORGENIX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY BUCKNER (SENIOR DIRECTOR)
(303) 457-4345
Entity
Organization
Contact information
Practice address
11575 MAIN ST UNIT 400, BROOMFIELD, CO 80020-2782
(303) 457-4345
Mailing address
11575 MAIN ST UNIT 400, BROOMFIELD, CO 80020-2782
(303) 457-4345
(303) 457-4519
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06D2146482
CLIA LICENSE
CO
01
—
8323392
CAP
CO
Enumeration date
02/21/2023
Last updated
02/22/2023
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