Healthcare Provider Details

I. General information

NPI: 1922616168
Provider Name (Legal Business Name): QUEST DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14590 STATE ROUTE 93 STE A
JACKSON OH
45640-8977
US

IV. Provider business mailing address

14275 MIDWAY RD STE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 740-286-2826
  • Fax:
Mailing address:
  • Phone: 214-932-8018
  • 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