Basic Information
| Provider Information | |||||||||
| NPI: | 1316004351 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST DIAGNOSTICS CLINICAL LABORATORIES INC | ||||||||
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| 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: | 146 PASSION PLAY RD | ||||||||
| Address2: | STE A | ||||||||
| City: | EUREKA SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726329455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792532463 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 09/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | CARTIER | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF REVENUE SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4846767000 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOTICS INCORPORATED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 04D1053567 | AR | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.