MEDICARE: MEDTOX LABORATORIES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	24D0665278	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487639381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTOX LABORATORIES, INC

Provider Business Mailing Address
First Line	:	402 COUNTY ROAD D W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-3522
Country	:	US
Telephone Number	:	800-832-3244
Fax Number	:	651-286-6249

Provider Business Practice Location Address
First Line	:	402 COUNTY ROAD D W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-3522
Country	:	US
Telephone Number	:	800-832-3244
Fax Number	:	651-286-6249

Authorized Official
Title or Position	:	VP
Name	:	KIMBERLY WILLIAMS
Credential	:
Telephone Number	:	800-222-7566

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	02/24/2014

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