Provider Demographics
NPI:1053339002
Name:QUEST DIAGNOSTICS INCORPORATED MI
Entity type:Organization
Organization Name:QUEST DIAGNOSTICS INCORPORATED MI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-676-7000
Mailing Address - Street 1:1001 ADAMS AVE
Mailing Address - Street 2:MRGOV 2ND FLOOR
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2429
Mailing Address - Country:US
Mailing Address - Phone:484-676-7000
Mailing Address - Fax:484-676-5309
Practice Address - Street 1:1695 W 12 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2182
Practice Address - Country:US
Practice Address - Phone:248-398-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0702537291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N26230Medicare ID - Type Unspecified
MI0N26230Medicare PIN