Basic Information
| Provider Information | |||||||||
| NPI: | 1235589102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIOREACTOR GENOMICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
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| City: | MAPLETON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560650337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024533799 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SUNRISE DR | ||||||||
| Address2: | |||||||||
| City: | SAINT PETER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560825376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024533799 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2016 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | SWANSON | ||||||||
| AuthorizedOfficialFirstName: | CHISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6129109642 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 40350 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.