Provider Demographics
NPI:1699095901
Name:LINEAGEN, INC.
Entity type:Organization
Organization Name:LINEAGEN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:HOLMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-931-6200
Mailing Address - Street 1:2677 E PARLEYS WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1617
Mailing Address - Country:US
Mailing Address - Phone:801-931-6200
Mailing Address - Fax:801-931-6201
Practice Address - Street 1:2677 E PARLEYS WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1617
Practice Address - Country:US
Practice Address - Phone:801-931-6200
Practice Address - Fax:801-931-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF92770Medicare PIN