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General NPI Number Information
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NPI Number | 1952951329
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Entity Type | Organization
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Legal Business Name | AMERICAN MOBILE DRUG TESTING / A DRUG FREE ALLIANCE
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 1200 W IRONWOOD DR STE 309
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2660
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Country | US
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Telephone | 208-665-0067
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Fax | 208-665-0068
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Provider Business Mailing Address
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Address Line | 1200 W IRONWOOD DR STE 309
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2660
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER LEICHTNAM
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Credential |
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Telephone | 509-994-2105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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