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General NPI Number Information
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NPI Number | 1033820899
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Entity Type | Organization
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Legal Business Name | SOUTHERN QUEST LLC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 1500 NW 62ND ST STE 406
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-1851
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Country | US
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Telephone | 954-546-4460
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Fax | 866-635-0548
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Provider Business Mailing Address
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Address Line | 1500 NW 62ND ST STE 406
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-1851
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Country | US
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Telephone | 954-546-4460
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Fax | 866-635-0546
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Authorized Official
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Title or Position | CEO
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Name | DARREN GRANT
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Credential |
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Telephone | 954-546-4460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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