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

General Provider Information

NPI Number	:	1851805915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST DIAGNOSTICS LLC IL

Provider Business Mailing Address
First Line	:	1201 S COLLEGEVILLE RD
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-2998
Country	:	US
Telephone Number	:	610-454-6146
Fax Number	:	484-676-5188

Provider Business Practice Location Address
First Line	:	11091 ULYSSES ST NE STE 100
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55434-4238
Country	:	US
Telephone Number	:	612-879-1000
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CHARLES ALBERT BOWLES
Credential	:
Telephone Number	:	610-454-4122

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	10/26/2018

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Directions to “QUEST DIAGNOSTICS LLC IL ” Practice Location

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