Basic Information
| Provider Information | |||||||||
| NPI: | 1578581104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST DIAGNOSTICS CLINICAL LABORATORIES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 ADAMS AVE | ||||||||
| Address2: | MRGOV 2ND FLOOR | ||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194032429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846767000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4230 HARDING RD | ||||||||
| Address2: | STE 420 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152504182 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | LAKE | ||||||||
| AuthorizedOfficialFirstName: | J PABLO | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REVENUE SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4846767000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 44D0975929 | TN | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 690008816 | 01 | TN | RAILROAD MEDICARE | OTHER |