MEDICARE: QUANTUM LABORATORIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	XXX	LA

General Provider Information

NPI Number	:	1578816948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUANTUM LABORATORIES LLC

Provider Business Mailing Address
First Line	:	3535 S SHERWOOD FOREST BLVD SUITE 251
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816
Country	:	US
Telephone Number	:	225-293-6222
Fax Number	:	225-293-6030

Provider Business Practice Location Address
First Line	:	3535 S SHERWOOD FOREST BLVD STE 251
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2255
Country	:	US
Telephone Number	:	225-293-6222
Fax Number	:	225-293-6030

Authorized Official
Title or Position	:	MANAGER
Name	:	LISA JANANI
Credential	:
Telephone Number	:	225-744-3004

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	10/22/2012

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