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NPI Code Detail

MEDICARE: QUEST DIAGNOSTICS LLC IL

MEDICARE: QUEST DIAGNOSTICS LLC IL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1053937219
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUEST DIAGNOSTICS LLC IL
Provider Business Mailing Address
First Line : 14275 MIDWAY RD STE 400
Second Line :
City : ADDISON
State : TX
Zip : 75001-3676
Country : US
Telephone Number : 214-932-8018
Fax Number : 610-271-4245
Provider Business Practice Location Address
First Line : 23030 STATE ROUTE 73 STE A
Second Line :
City : WEST PORTSMOUTH
State : OH
Zip : 45663-8861
Country : US
Telephone Number : 740-858-1063
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : CHARLES ALBERT BOWLES
Credential :
Telephone Number : 610-454-6000
Provider Enumeration Date : 06/23/2020
Last Update Date : 06/23/2020

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Directions to “QUEST DIAGNOSTICS LLC IL ” Practice Location

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