Basic Information
| Provider Information | |||||||||
| NPI: | 1619313863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST DIAGNOSTICS MASSACHUSETTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 S COLLEGEVILLE RD | ||||||||
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| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194262998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666978378 | ||||||||
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| Practice Location | |||||||||
| Address1: | 191 MAY ST | ||||||||
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| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016024353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088520600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2013 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | BETZ | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4129207774 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOSTICS LLC MA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.