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NPI Code Detail

MEDICARE: LINEAGEN, INC.

MEDICARE: LINEAGEN, INC.
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 : 1699095901
Entity Type Code : Organization
Provider Name (Legal Business Name) : LINEAGEN, INC.
Provider Business Mailing Address
First Line : 2677 E PARLEYS WAY
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1617
Country : US
Telephone Number : 801-931-6200
Fax Number : 801-931-6201
Provider Business Practice Location Address
First Line : 2677 E PARLEYS WAY
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1617
Country : US
Telephone Number : 801-931-6200
Fax Number : 801-931-6201
Authorized Official
Title or Position : CEO
Name : ROBERT ERIK HOLMLIN
Credential : PHD
Telephone Number : 801-931-6200
Provider Enumeration Date : 06/09/2010
Last Update Date : 09/23/2022

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