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General NPI Number Information
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NPI Number | 1902390628
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Entity Type | Organization
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Legal Business Name | QUEST DIAGNOSTICS MASSACHUSETTS LLC
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Dates
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Enumeration Date | 06/16/2018
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 69 CAMP ST
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City | HYANNIS
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State | MA
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Zip | 02601-3046
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Country | US
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Telephone | 508-778-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S COLLEGEVILLE RD
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2998
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Country | US
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Telephone | 508-778-4100
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID MICHAEL BETZ
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Credential |
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Telephone | 412-920-7774
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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 | 22D0080952
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License Number State | MA
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