Basic Information
| Provider Information | |||||||||
| NPI: | 1285244616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST DIAGNOSTICS LLC IL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 S COLLEGEVILLE RD | ||||||||
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| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194262998 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 895 7TH ST E | ||||||||
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| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551063871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666978378 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2020 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOWLES | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | ALBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6104546000 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOSTICS INCORPORATED | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.