Basic Information
Provider Information
NPI: 1215071501
EntityType: 2
ReplacementNPI:  
OrganizationName: LAB ONE INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: QUEST DIAGNOSTICS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 ADAMS AVE MRGOV
Address2: 2ND FLOOR
City: NORRISTOWN
State: PA
PostalCode: 194032429
CountryCode: US
TelephoneNumber: 4846767000
FaxNumber: 4846765309
Practice Location
Address1: 5400 NORTH OAK
Address2: SUITE 105
City: KANSAS CITY
State: MO
PostalCode: 641184688
CountryCode: US
TelephoneNumber: 8164522484
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/19/2007
LastUpdateDate: 09/21/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CARTIER
AuthorizedOfficialFirstName: GERALD
AuthorizedOfficialMiddleName: SCOTT
AuthorizedOfficialTitleorPosition: VP OF REVENUE SERVICES
AuthorizedOfficialTelephone: 4846767000
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: QUEST DIAGNOSTICS INCORPORATED
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
291U00000X26D1024967KSY LaboratoriesClinical Medical Laboratory 

No ID Information.


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