Provider Demographics
NPI:1437280708
Name:QUEST DIAGNOSTICS OF PUERTO RICO INC
Entity Type:Organization
Organization Name:QUEST DIAGNOSTICS OF PUERTO RICO INC
Other - Org Name:QUEST DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-676-7000
Mailing Address - Street 1:2750 MONROE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROAD # 2 KM 11.8, FEDERAL BUILDING
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-787-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31427Medicare PIN