NPIMap

Organization Active NPI

Sonora Quest Laboratories LLC

  • Clinical Medical Laboratory
  • Tucson, AZ
National Provider Identifier
1104207778
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
03D2096833 Issued in AZ
Legal business name
SONORA QUEST LABORATORIES LLC
Practice address
2070 W Rudasill Rd
Suite 130
Tucson, AZ 85704-7891
Phone
(520) 544-3641
Fax
(520) 544-3739
NPI assigned
Jun 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David A Dexter, CEO
Title
President/Ceo
Phone
(602) 685-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 03D2096833 AZ Primary

Addresses

Primary practice location

2070 W Rudasill Rd
Suite 130
Tucson, AZ 85704-7891

Mailing address

PO Box 67150
Phoenix, AZ 85082-7150
Phone (602) 685-5000

Other identifiers 1

IdentifierTypeStateIssuer
452152MedicaidAZ

Other names 1

  • Sonora Quest Laboratories - Rudasil Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040714001218 AZ Part B Supplier - Independent Clinical Laboratory 4688653629 23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Peoria, AZ; Phoenix, AZ; Tempe, AZ; Tucson, AZ; Yuma, AZ

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory

Locations

2070 W Rudasill Rd
Ste 130
Tucson, AZ 85704
Phone (520) 420-2520

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1104207778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850827150",
            "telephone_number": "602-685-5000",
            "fax_number": "602-685-5903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2070 W RUDASILL RD",
            "address_2": "SUITE 130",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857047891",
            "telephone_number": "520-544-3641",
            "fax_number": "520-544-3739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONORA QUEST LABORATORIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-09",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A",
        "authorized_official_last_name": "DEXTER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "602-685-5000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "03D2096833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "452152",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sonora Quest Laboratories - Rudasil",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Sonora Quest Laboratories - Rudasil",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.