Basic Information
| Provider Information | |||||||||
| NPI: | 1497041073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAB ONE LLC | ||||||||
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| OtherOrganizationName: | QUEST DIAGNOSTICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 408 LINCOLN DRIVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HERRIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629483757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189930498 | ||||||||
| FaxNumber: | 6189930529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | LAKE | ||||||||
| AuthorizedOfficialFirstName: | J PABLO | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REVENUE SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4846767000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOSTICS INCORPORATED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.