MEDICARE: QUEST DIAGNOSTICS CLINICAL LABORATORIES INC

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	:	1942853551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST DIAGNOSTICS CLINICAL LABORATORIES INC

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD STE 400
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3661
Country	:	US
Telephone Number	:	866-697-8378
Fax Number	:	610-271-4245

Provider Business Practice Location Address
First Line	:	850 OLIVE ST STE A
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2162
Country	:	US
Telephone Number	:	866-697-8378
Fax Number	:

Authorized Official
Title or Position	:	SR. VICE PRESIDENT
Name	:	LEAH D TIMMERMAN
Credential	:
Telephone Number	:	973-520-2700

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	11/20/2024

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