=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861633216
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUEST DIAGNOSTICS INCORPORATED MI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2009
-----------------------------------------------------
Last Update Date | 09/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 543 N MAIN ST STE 223
-----------------------------------------------------
City | ROCHESTER HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307-1485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-650-1090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 ADAMS AVE MRGOV 2ND FLOOR
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19403-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-676-7000
-----------------------------------------------------
Fax | 484-676-5309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF REVENUE SERVICES
-----------------------------------------------------
Name | GERALD SCOTT CARTIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-676-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 23D1093446
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------