1861633216 NPI number — QUEST DIAGNOSTICS INCORPORATED MI

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861633216 NPI number — QUEST DIAGNOSTICS INCORPORATED MI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUEST DIAGNOSTICS INCORPORATED MI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861633216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 ADAMS AVE MRGOV
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19403-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-676-7000
Provider Business Mailing Address Fax Number:
484-676-5309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 N MAIN ST STE 223
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-1485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-650-1090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CARTIER
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
VP OF REVENUE SERVICES
Authorized Official Telephone Number:
484-676-7000

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  23D1093446 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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