Provider Demographics
NPI:1710906342
Name:QUEST DIAGNOSTICS LLC IL
Entity Type:Organization
Organization Name:QUEST DIAGNOSTICS LLC IL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP NATIONAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:G.
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 1:2750 MONROE BLVD
Mailing Address - Street 2:MR200
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2429
Mailing Address - Country:US
Mailing Address - Phone:484-676-7331
Mailing Address - Fax:
Practice Address - Street 1:870 W END CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1383
Practice Address - Country:US
Practice Address - Phone:847-362-5323
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:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
570920Medicare ID - Type Unspecified
IL570920Medicare PIN