Healthcare Provider Details

I. General information

NPI: 1154559078
Provider Name (Legal Business Name): SAN QUEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 E NORTH ST
GREENVILLE SC
29607-1374
US

IV. Provider business mailing address

1635 E NORTH ST
GREENVILLE SC
29607-1374
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-3301
  • Fax: 864-939-0288
Mailing address:
  • Phone: 864-271-3306
  • Fax: 864-939-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS ANDRES CANIPE
Title or Position: VICE PRESIDENT
Credential:
Phone: 864-271-3301