MEDICARE: BIOQUEST DIAGNOSTICS 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	:	1407519887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOQUEST DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	4500 BOWLING BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-5147
Country	:	US
Telephone Number	:	502-909-3024
Fax Number	:	502-909-3024

Provider Business Practice Location Address
First Line	:	4500 BOWLING BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-5147
Country	:	US
Telephone Number	:	502-909-3024
Fax Number	:	502-909-3024

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIAMOND CALLOWAY
Credential	:
Telephone Number	:	502-656-9261

Provider Enumeration Date	:	10/21/2021
Last Update Date	:	10/21/2021

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