Provider Demographics
NPI:1447022819
Name:NXGEN MDX, LLC
Entity type:Organization
Organization Name:NXGEN MDX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-343-0402
Mailing Address - Street 1:801 BROADWAY AVE NW STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4463
Mailing Address - Country:US
Mailing Address - Phone:855-776-9436
Mailing Address - Fax:616-710-4667
Practice Address - Street 1:801 BROADWAY AVE NW STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4463
Practice Address - Country:US
Practice Address - Phone:855-776-9436
Practice Address - Fax:616-710-4667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAL LABORATORY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics