Provider Demographics
NPI:1598460990
Name:IQGENETIX LLC
Entity Type:Organization
Organization Name:IQGENETIX LLC
Other - Org Name:IQGENETIX LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-921-2415
Mailing Address - Street 1:10300 EATON PL STE 440
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2239
Mailing Address - Country:US
Mailing Address - Phone:866-921-2415
Mailing Address - Fax:703-738-7895
Practice Address - Street 1:10300 EATON PL STE 440
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2239
Practice Address - Country:US
Practice Address - Phone:866-921-2415
Practice Address - Fax:703-738-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory