Provider Demographics
NPI:1497773444
Name:UNILAB CORPORATION
Entity Type:Organization
Organization Name:UNILAB CORPORATION
Other - Org Name:DBA QUEST DIAGNOSTICS INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF REVENUE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-676-7731
Mailing Address - Street 1:1001 ADAMS AVE
Mailing Address - Street 2:MRGOV 2ND FLOOR
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2429
Mailing Address - Country:US
Mailing Address - Phone:484-676-7705
Mailing Address - Fax:484-676-5309
Practice Address - Street 1:4204 RIVERWALK PARKWAY
Practice Address - Street 2:SUITE 340
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3391
Practice Address - Country:US
Practice Address - Phone:951-602-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0703624291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D0703624Medicare ID - Type Unspecified