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General NPI Number Information
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NPI Number | 1114308863
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Entity Type | Organization
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Legal Business Name | COALITION TOXICOLOGY, LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 555 HERITAGE DR STE 130
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City | JUPITER
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State | FL
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Zip | 33458-5285
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Country | US
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Telephone | 561-299-8122
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Fax |
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Provider Business Mailing Address
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Address Line | 639 E OCEAN AVE STE 205
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-5011
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Country | US
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Telephone | 561-299-8122
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL BROWN
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Credential |
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Telephone | 561-299-8122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800027320
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License Number State | FL
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