Provider Demographics
NPI:1578804282
Name:SONORA QUEST LABORATORIES LLC
Entity Type:Organization
Organization Name:SONORA QUEST LABORATORIES LLC
Other - Org Name:SONORA QUEST LABORATORIES OF NORTHERN ARIZONA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:602-685-5000
Mailing Address - Street 1:PO BOX 67150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-7150
Mailing Address - Country:US
Mailing Address - Phone:602-685-5000
Mailing Address - Fax:602-685-5903
Practice Address - Street 1:3161 N WINDSONG DR
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2213
Practice Address - Country:US
Practice Address - Phone:928-772-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D2003652291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ452152Medicaid
AZZ24689Medicare UPIN