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General NPI Number Information
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NPI Number | 1649804436
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Entity Type | Organization
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Legal Business Name | INDEPENDENT DRUG TESTING AND FORENSIC SERVICES
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 4213 MONTGOMERY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1103
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Country | US
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Telephone | 505-255-1190
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Fax | 505-345-5799
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Provider Business Mailing Address
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Address Line | 4800 140TH AVENUE STE 102
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City | CLEARWATER
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State | FL
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Zip | 33762-5708
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Country | US
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Telephone | 505-255-1190
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Fax | 505-345-5799
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Authorized Official
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Title or Position | CEO
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Name | RON SMOCK
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Credential |
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Telephone | 505-255-1190
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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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