Provider Demographics
NPI:1306291901
Name:OMEGAQUANT
Entity type:Organization
Organization Name:OMEGAQUANT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:605-271-6917
Mailing Address - Street 1:5009 W 12TH ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3988
Mailing Address - Country:US
Mailing Address - Phone:605-271-6917
Mailing Address - Fax:
Practice Address - Street 1:5009 W 12TH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3988
Practice Address - Country:US
Practice Address - Phone:605-271-6917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDL019088291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD43D1105229OtherCLIA