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NPI Code Detail

MEDICARE: IQGENETIX LLC

MEDICARE: IQGENETIX 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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1598460990
Entity Type Code : Organization
Provider Name (Legal Business Name) : IQGENETIX LLC
Provider Business Mailing Address
First Line : 10300 EATON PL STE 440
Second Line :
City : FAIRFAX
State : VA
Zip : 22030-2239
Country : US
Telephone Number : 866-921-2415
Fax Number : 703-738-7895
Provider Business Practice Location Address
First Line : 10300 EATON PL STE 440
Second Line :
City : FAIRFAX
State : VA
Zip : 22030-2239
Country : US
Telephone Number : 866-921-2415
Fax Number : 703-738-7895
Authorized Official
Title or Position : CEO
Name : JEFFREY GLENN MOHLER
Credential :
Telephone Number : 866-921-2415
Provider Enumeration Date : 04/04/2023
Last Update Date : 05/19/2023

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Directions to “IQGENETIX LLC ” Practice Location

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