Basic Information
Provider Information
NPI: 1568506889
EntityType: 2
ReplacementNPI:  
OrganizationName: LABONE INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: QUEST DIAGNOSTICS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2750 MONROE BLVD
Address2: MRGOV 2ND FLOOR
City: NORRISTOWN
State: PA
PostalCode: 194032429
CountryCode: US
TelephoneNumber: 4846767000
FaxNumber:  
Practice Location
Address1: 15101 GLENWOOD AVE
Address2:  
City: STANLEY
State: KS
PostalCode: 662233154
CountryCode: US
TelephoneNumber: 9136818866
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/19/2007
LastUpdateDate: 04/26/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CARTIER
AuthorizedOfficialFirstName: GERALD
AuthorizedOfficialMiddleName: SCOTT
AuthorizedOfficialTitleorPosition: VP OF REVENUE SERVICES
AuthorizedOfficialTelephone: 4846767731
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: QUEST DIAGNOSTICS INCORPORATED
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
291U00000X17D0449723KSY LaboratoriesClinical Medical Laboratory 

No ID Information.


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