Basic Information
| Provider Information | |||||||||
| NPI: | 1225695075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAB ONE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 S COLLEGEVILLE RD | ||||||||
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| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194262998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104546000 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 UNITED DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720327829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015042700 | ||||||||
| FaxNumber: | 5015042717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2019 | ||||||||
| LastUpdateDate: | 05/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | BOWLES | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | ALBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6104546000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOSTICS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.