Healthcare Provider Details

I. General information

NPI: 1144460908
Provider Name (Legal Business Name): DRUG TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SW SEMINOLE ST APT 3
STUART FL
34994-2160
US

IV. Provider business mailing address

45 SW SEMINOLE ST APT 3
STUART FL
34994-2160
US

V. Phone/Fax

Practice location:
  • Phone: 602-332-1573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARC SLOBASKY
Title or Position: CEO
Credential:
Phone: 904-536-2967