Provider Demographics
NPI:1740023118
Name:IGNITE PROTEOMICS LLC
Entity type:Organization
Organization Name:IGNITE PROTEOMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPEICALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-459-0780
Mailing Address - Street 1:3401 MALLORY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8369
Mailing Address - Country:US
Mailing Address - Phone:484-459-0780
Mailing Address - Fax:
Practice Address - Street 1:15000 W 6TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5047
Practice Address - Country:US
Practice Address - Phone:720-420-0074
Practice Address - Fax:720-302-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory