Provider Demographics
NPI:1225544117
Name:QUANTUM DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:QUANTUM DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-440-2101
Mailing Address - Street 1:5199 10TH AVE N STE 105
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2050
Mailing Address - Country:US
Mailing Address - Phone:561-440-2101
Mailing Address - Fax:561-440-2299
Practice Address - Street 1:5199 10TH AVE N STE 105
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2050
Practice Address - Country:US
Practice Address - Phone:561-440-2101
Practice Address - Fax:561-440-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800028779291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory