Active NPI
Quest Diagnostics LLC Il
- Clinical Medical Laboratory
- Blaine, MN
National Provider Identifier
1851805915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- QUEST DIAGNOSTICS LLC IL
- Practice address
- 11091 Ulysses St NE Ste 100
Blaine, MN 55434-4238 - Phone
- (612) 879-1000
- NPI assigned
- Nov 28, 2017
- Last updated
- Oct 26, 2018
- Organization subpart
- Yes
- Parent organization
- QUEST DIAGNOSTICS INCORPORATED
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charles Albert Bowles
- Title
- Vice President
- Phone
- (610) 454-4122
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
11091 Ulysses St NE Ste 100
Blaine, MN 55434-4238
Mailing address
1201 S Collegeville Rd
Collegeville, PA 19426-2998
Phone (610) 454-6146
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040416001014 | MN | Part B Supplier - Independent Clinical Laboratory | 3779474986 |
4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Saint Paul, MN; Minneapolis, MN |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Quest Diagnostics LLC
- Clinical Medical Laboratory
- Saint Paul, MN
- NPI 1285244616
O20040416001014
National Provider Directory
National Provider Directory- Part of
- Quest Diagnostics Inc P
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511827200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1540512000000",
"number": "1851805915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 S COLLEGEVILLE RD",
"city": "COLLEGEVILLE",
"state": "PA",
"postal_code": "194262998",
"telephone_number": "610-454-6146",
"fax_number": "484-676-5188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11091 ULYSSES ST NE STE 100",
"city": "BLAINE",
"state": "MN",
"postal_code": "554344238",
"telephone_number": "612-879-1000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "QUEST DIAGNOSTICS LLC IL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "QUEST DIAGNOSTICS INCORPORATED",
"enumeration_date": "2017-11-28",
"last_updated": "2018-10-26",
"status": "A",
"authorized_official_last_name": "BOWLES",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "ALBERT",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "610-454-4122"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2018; 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.