Healthcare Provider Details

I. General information

NPI: 1740705482
Provider Name (Legal Business Name): QUEST DIAGNOSTICS CLINICAL LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 OFFICE BLVD NE
ALBUQUERQUE NM
87109-5879
US

IV. Provider business mailing address

1201 S COLLEGEVILLE RD
COLLEGEVILLE PA
19426-2998
US

V. Phone/Fax

Practice location:
  • Phone: 505-449-3294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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