Provider Demographics
NPI:1033820899
Name:SOUTHERN QUEST LLC
Entity Type:Organization
Organization Name:SOUTHERN QUEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-546-4460
Mailing Address - Street 1:1500 NW 62ND ST STE 406
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1851
Mailing Address - Country:US
Mailing Address - Phone:954-546-4460
Mailing Address - Fax:866-635-0546
Practice Address - Street 1:1500 NW 62ND ST STE 406
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1851
Practice Address - Country:US
Practice Address - Phone:954-546-4460
Practice Address - Fax:866-635-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory