Provider Demographics
NPI:1689084667
Name:QUEST DIAGNOSTICS INCORPORATED MI
Entity Type:Organization
Organization Name:QUEST DIAGNOSTICS INCORPORATED MI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:J PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-676-7000
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:484-676-7000
Mailing Address - Fax:
Practice Address - Street 1:4045 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6640
Practice Address - Country:US
Practice Address - Phone:248-288-2160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory