NPIMap

Organization Active NPI

Quest Diagnostics of Pennsylvania Inc

  • Clinical Medical Laboratory
  • Boardman, OH
National Provider Identifier
1962659656
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
36D1067585 Issued in OH
Legal business name
QUEST DIAGNOSTICS OF PENNSYLVANIA INC
Practice address
835 Southwestern Run
Laboratory
Boardman, OH 44514-0000
Phone
(330) 318-1118
NPI assigned
Aug 25, 2008
Organization subpart
Yes
Parent organization
QUEST DIAGNOSTICS INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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) 454-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 36D1067585 OH Primary

Addresses

Primary practice location

835 Southwestern Run
Laboratory
Boardman, OH 44514-0000

Mailing address

1201 S Collegeville Rd
Collegeville, PA 19426-2998
Phone (666) 978-3788

Other names 1

  • Quest Diagnostics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040127000652 OH Part B Supplier - Independent Clinical Laboratory 2365345550 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boardman, OH; Twinsburg, OH; Warren, OH

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1067585Quest Diagnostics of Pennsylvania Inc835 Southwestern Run Road, Poland, OH 44514ComplianceNov 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
MDS Laboratories8 organizations share this tax ID, including this one
Part of
Questdiagnost Ic Inc

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

200 Gateway Park Dr
#A
North Syracuse, NY 13212
Phone (315) 453-9257

10224 Alliance Rd
Blue Ash, OH 45242
Phone (513) 891-7211

2500 W Strub Rd
Ste 140
Sandusky, OH 44870
Phone (419) 625-8396

2451 Edison Blvd
Twinsburg, OH 44087
Phone (330) 487-5511

2750 Monroe Blvd
Fl 2
Norristown, PA 19403

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665360000000",
    "number": "1962659656",
    "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": "666-978-3788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 SOUTHWESTERN RUN",
            "address_2": "LABORATORY",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445140000",
            "telephone_number": "330-318-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEST DIAGNOSTICS OF PENNSYLVANIA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUEST DIAGNOSTICS INCORPORATED",
        "enumeration_date": "2008-08-25",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "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": "610-454-6000"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OH",
            "license": "36D1067585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quest Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Quest Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.