MEDICARE: QUEST DIAGNOSTICS CLINICAL LABORATORIES INC

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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1295489441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST DIAGNOSTICS CLINICAL LABORATORIES INC

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD STE 400
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3614
Country	:	US
Telephone Number	:
Fax Number	:	610-271-4245

Provider Business Practice Location Address
First Line	:	100 CUNNINGHAM LN
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-3923
Country	:	US
Telephone Number	:	919-359-1011
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CHARLES ALBERT BOWLES
Credential	:
Telephone Number	:	610-454-6000

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	12/30/2022

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