Provider Demographics
NPI:1356369318
Name:QUEST DIAGNOSTICS CLINICAL LAB INC.
Entity type:Organization
Organization Name:QUEST DIAGNOSTICS CLINICAL LAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-454-6000
Mailing Address - Street 1:2750 MONROE BLVD
Mailing Address - Street 2:MR200
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2429
Mailing Address - Country:US
Mailing Address - Phone:484-676-7331
Mailing Address - Fax:
Practice Address - Street 1:1001 S 70TH ST
Practice Address - Street 2:STE 111
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-7901
Practice Address - Country:US
Practice Address - Phone:402-465-1724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28D0938166291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
099403Medicare ID - Type Unspecified