Provider Demographics
NPI:1366849200
Name:QUANTIGEN LLC
Entity Type:Organization
Organization Name:QUANTIGEN LLC
Other - Org Name:QUANTIGEN GENOMICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-385-4079
Mailing Address - Street 1:10300 KINCAID DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8509
Mailing Address - Country:US
Mailing Address - Phone:317-578-8980
Mailing Address - Fax:317-578-8988
Practice Address - Street 1:10300 KINCAID DR STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8509
Practice Address - Country:US
Practice Address - Phone:317-578-8980
Practice Address - Fax:317-578-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15D2076283291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory