Provider Demographics
NPI:1366803447
Name:QR DIAGNOSTICS LLC
Entity type:Organization
Organization Name:QR DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-859-3413
Mailing Address - Street 1:12734 KENWOOD LN
Mailing Address - Street 2:UNIT 68
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5666
Mailing Address - Country:US
Mailing Address - Phone:561-859-3413
Mailing Address - Fax:561-423-0104
Practice Address - Street 1:12734 KENWOOD LN
Practice Address - Street 2:UNIT 68
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5666
Practice Address - Country:US
Practice Address - Phone:561-859-3413
Practice Address - Fax:561-423-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory