Healthcare Provider Details

I. General information

NPI: 1912925975
Provider Name (Legal Business Name): QUEST DIAGNOSTICS LLC IL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17130 TORRENCE AVE STE 420
LANSING IL
60438-6042
US

IV. Provider business mailing address

1001 ADAMS AVE MRGOV 2ND FLOOR
NORRISTOWN PA
19403-2429
US

V. Phone/Fax

Practice location:
  • Phone: 708-418-0551
  • Fax:
Mailing address:
  • Phone: 484-676-7000
  • Fax: 484-676-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number14D0988425
License Number StateIL

VIII. Authorized Official

Name: GERALD SCOTT CARTIER
Title or Position: VP OF REVENUE SERVICES
Credential:
Phone: 484-676-7000