Provider Demographics
NPI:1396936050
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:
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-697-8378
Mailing Address - Street 1:1001 ADAMS AVE MRGOV
Mailing Address - Street 2:2ND 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:484-676-5309
Practice Address - Street 1:1501 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3378
Practice Address - Country:US
Practice Address - Phone:256-353-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-07
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01D0893715291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
051555084Medicare PIN