Healthcare Provider Details

I. General information

NPI: 1649804436
Provider Name (Legal Business Name): INDEPENDENT DRUG TESTING AND FORENSIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1103
US

IV. Provider business mailing address

4800 140TH AVENUE STE 102
CLEARWATER FL
33762-5708
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1190
  • Fax: 505-345-5799
Mailing address:
  • Phone: 505-255-1190
  • Fax: 505-345-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RON SMOCK
Title or Position: CEO
Credential:
Phone: 505-255-1190