Provider Demographics
NPI:1649878364
Name:IQGENETIX LLC
Entity type:Organization
Organization Name:IQGENETIX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-416-4364
Mailing Address - Street 1:11225 ASSETT LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3994
Mailing Address - Country:US
Mailing Address - Phone:866-921-2415
Mailing Address - Fax:571-379-4847
Practice Address - Street 1:11225 ASSETT LOOP STE 100
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3994
Practice Address - Country:US
Practice Address - Phone:866-921-2415
Practice Address - Fax:571-379-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory