Basic Information
Provider Information | |||||||||
NPI: | 1275677429 | ||||||||
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: | 11725 W 112TH ST | ||||||||
Address2: |   | ||||||||
City: | OVERLAND PARK | ||||||||
State: | KS | ||||||||
PostalCode: | 662102761 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4846767731 | ||||||||
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
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 17D0449337 | KS | Y |   | Laboratories | Clinical Medical Laboratory |   |
No ID Information.