Provider Demographics
NPI:1154559078
Name:SAN QUEST, LLC
Entity type:Organization
Organization Name:SAN QUEST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:CANIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-271-3301
Mailing Address - Street 1:1635 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1374
Mailing Address - Country:US
Mailing Address - Phone:864-271-3306
Mailing Address - Fax:864-939-0288
Practice Address - Street 1:1635 E NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1374
Practice Address - Country:US
Practice Address - Phone:864-271-3301
Practice Address - Fax:864-939-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42D2039933OtherCLIA