Provider Demographics
NPI:1336809862
Name:QUANTUM LABORATORY SERVICES LLC
Entity type:Organization
Organization Name:QUANTUM LABORATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOGREFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-733-4305
Mailing Address - Street 1:824 N CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4711
Mailing Address - Country:US
Mailing Address - Phone:800-733-4305
Mailing Address - Fax:
Practice Address - Street 1:824 N CREEK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4711
Practice Address - Country:US
Practice Address - Phone:800-733-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-24
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR281864709Medicaid
AR2B8549OtherMEDICARE
AR04D2217768OtherCLIA