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General NPI Number Information
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NPI Number | 1194743153
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Entity Type | Organization
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Legal Business Name | QUEST DIAGNOSTICS CLINICAL LABORATORIES INC.
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 9050 E 29TH ST N STE 80
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City | WICHITA
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State | KS
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Zip | 67226-2191
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Country | US
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Telephone | 316-685-5185
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Fax | 316-685-8571
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Provider Business Mailing Address
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Address Line | 1001 ADAMS AVE 2ND FLOOR MRGOV
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City | NORRISTOWN
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State | PA
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Zip | 19403-2429
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Country | US
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Telephone | 484-676-7000
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Fax | 484-676-5309
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Authorized Official
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Title or Position | VP OF REVENUE SERVICES
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Name | J PABLO LAKE
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Credential |
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Telephone | 484-676-7000
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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 | 17D0912191
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License Number State | KS
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