Provider Demographics
NPI:1548133598
Name:GENESEQ LABORATORY LLC
Entity type:Organization
Organization Name:GENESEQ LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:NAGAMPETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-449-4259
Mailing Address - Street 1:2727 LYNDON B JOHNSON FWY STE 766
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7670
Mailing Address - Country:US
Mailing Address - Phone:682-449-4259
Mailing Address - Fax:
Practice Address - Street 1:2727 LYNDON B JOHNSON FWY STE 766
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7670
Practice Address - Country:US
Practice Address - Phone:682-449-4259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory