Provider Demographics
NPI:1659702181
Name:SONORA QUEST LABORATORIES, LLC
Entity Type:Organization
Organization Name:SONORA QUEST LABORATORIES, LLC
Other - Org Name:SONORA QUEST LABORATORIES OF SUN CITY WEST
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:14420 W MEEKER BLVD
Practice Address - Street 2:STE 109
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5286
Practice Address - Country:US
Practice Address - Phone:623-583-5072
Practice Address - Fax:623-583-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D0864619291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ452152Medicaid
AZ452152Medicaid