Provider Demographics
NPI:1750494209
Name:ONCOTECH INC
Entity Type:Organization
Organization Name:ONCOTECH INC
Other - Org Name:EXIQON DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMMERCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-566-0470
Mailing Address - Street 1:15501 RED HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-566-0420
Mailing Address - Fax:714-566-0471
Practice Address - Street 1:15501 RED HILL AVENUE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-566-0420
Practice Address - Fax:714-566-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 4785291U00000X
CA4785-STATE LICENSE291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01464390Medicaid
FL030483200Medicaid
AZ160820Medicaid
IN100384230AMedicaid
CALAB09008FMedicaid
MD0805289Medicaid
KS100245170AMedicaid
SCL00034Medicaid
NC7001073Medicaid
AK125472709Medicaid
CO98002652Medicaid
KY37903010Medicaid
CAX059008Medicaid
TN4490705Medicaid
NJ6228003Medicaid
GA00768644AMedicaid
WA7060627Medicaid
MO707653606Medicaid
WA7060627Medicaid
PA01464390Medicaid