Provider Demographics
NPI:1164017422
Name:QUANTUM FORMULA DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:QUANTUM FORMULA DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-675-4774
Mailing Address - Street 1:2911 TURTLE CREEK BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-6290
Mailing Address - Country:US
Mailing Address - Phone:214-675-4774
Mailing Address - Fax:214-594-0379
Practice Address - Street 1:1451 EMPIRE CENTRAL DR STE 100A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4139
Practice Address - Country:US
Practice Address - Phone:214-675-4774
Practice Address - Fax:214-580-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory