Provider Demographics
NPI:1578581104
Name:QUEST DIAGNOSTICS CLINICAL LABORATORIES INC
Entity Type:Organization
Organization Name:QUEST DIAGNOSTICS CLINICAL LABORATORIES INC
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:866-697-8378
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:866-697-8378
Mailing Address - Fax:
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:STE 420
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2098
Practice Address - Country:US
Practice Address - Phone:615-250-4182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44D0975929291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN690008816OtherRAILROAD MEDICARE
3403043Medicare ID - Type Unspecified