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NPI Code Detail

MEDICARE: IQ LABORATORIES INC

MEDICARE: IQ LABORATORIES 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 LaboratoryIN

General Provider Information

NPI Number : 1851633069
Entity Type Code : Organization
Provider Name (Legal Business Name) : IQ LABORATORIES INC
Provider Business Mailing Address
First Line : 6819 LIMA RD
Second Line : SUITE 200
City : FORT WAYNE
State : IN
Zip : 46818-1145
Country : US
Telephone Number : 260-407-6216
Fax Number :
Provider Business Practice Location Address
First Line : 6819 LIMA RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-1145
Country : US
Telephone Number : 260-407-6216
Fax Number :
Authorized Official
Title or Position : VP AUCILLARY SERVICES
Name : CAREY GROSS
Credential :
Telephone Number : 260-407-6216
Provider Enumeration Date : 03/26/2013
Last Update Date : 02/14/2014

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Directions to “IQ LABORATORIES INC ” Practice Location

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