Healthcare Provider Details

I. General information

NPI: 1083205942
Provider Name (Legal Business Name): QUEST DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 W FULLERTON AVE
CHICAGO IL
60647-2228
US

IV. Provider business mailing address

1201 S COLLEGEVILLE RD
COLLEGEVILLE PA
19426-2998
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-2229
  • Fax: 773-276-2190
Mailing address:
  • Phone: 610-454-6146
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ALBERT BOWLES
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-454-6000