MEDICARE: QUEST DIAGNOSTICS LLC IL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		IL

General Provider Information

NPI Number	:	1538189238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST DIAGNOSTICS LLC IL

Provider Business Mailing Address
First Line	:	2750 MONROE BLVD
Second Line	:	MR200
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-2429
Country	:	US
Telephone Number	:	484-676-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	STE 907
City	:	CHICAGO
State	:	IL
Zip	:	60611-8701
Country	:	US
Telephone Number	:	312-482-9593
Fax Number	:

Authorized Official
Title or Position	:	VP NATIONAL BILLING
Name	:	G. SCOTT CARTIER
Credential	:
Telephone Number	:	484-676-7000

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	01/10/2008

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