Provider Demographics
NPI:1063023612
Name:QUEST DIAGNOSTICS
Entity Type:Organization
Organization Name:QUEST DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-454-6000
Mailing Address - Street 1:14275 MIDWAY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8018
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:621 BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4788
Practice Address - Country:US
Practice Address - Phone:740-961-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory