Healthcare Provider Details

I. General information

NPI: 1699176768
Provider Name (Legal Business Name): NEOGENOMICS LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JENNER SUITE 180
IRVINE CA
92618
US

IV. Provider business mailing address

12701 COMMONWEALTH DR SUITE 9
FORT MYERS FL
33913-8626
US

V. Phone/Fax

Practice location:
  • Phone: 866-776-5907
  • Fax: 949-206-1865
Mailing address:
  • Phone: 866-776-5907
  • Fax: 239-768-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF00346265
License Number StateCA

VIII. Authorized Official

Name: SHARON A VIRAG
Title or Position: CFO
Credential:
Phone: 866-776-5907