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General NPI Number Information
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NPI Number | 1376152983
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Entity Type | Organization
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Legal Business Name | SPORTS DRUG TESTING LABORATORY, LLC
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 10644 S JORDAN GTWY STE 200
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4036
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Country | US
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Telephone | 801-994-9454
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Fax | 801-994-9455
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Provider Business Mailing Address
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Address Line | 10644 S JORDAN GTWY STE 200
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4036
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Country | US
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Telephone | 801-994-9454
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Fax | 801-994-9455
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Authorized Official
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Title or Position | CFO/CAO/TREASURER
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Name | MS. KIM MARIE MONTI
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Credential |
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Telephone | 801-994-9464
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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 |
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License Number State |
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