=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013253053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSURE DRUG DETECTION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2012
-----------------------------------------------------
Last Update Date | 12/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 607 ADAMS AVE
-----------------------------------------------------
City | LA GRANDE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97850-1663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-605-0355
-----------------------------------------------------
Fax | 360-684-6299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2031
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83816-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-605-0355
-----------------------------------------------------
Fax | 360-684-6299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOEL E LAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-605-0355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 38D2039090
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------