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General NPI Number Information
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NPI Number | 1639404593
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Entity Type | Organization
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Legal Business Name | RX DRUG MONITORING LABORATORY, LLC
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Dates
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Enumeration Date | 10/11/2009
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Last Update Date | 10/31/2013
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Provider Practice Location Address
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Address Line | 660 LAKEWAY DRIVE SUITE A
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642
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Country | US
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Telephone | 270-866-9608
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Fax | 270-866-9609
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Provider Business Mailing Address
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Address Line | PO BOX 1420 660 LAKEWAY DRIVE SUITE A
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642
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Country | US
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Telephone | 270-866-9608
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Fax | 270-866-9609
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES W. BOTTOM
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Credential |
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Telephone | 270-866-9608
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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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