Basic Information
| Provider Information | |||||||||
| NPI: | 1285890723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSURANCE DRUG TESTING LABORATORIES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6040 W LISBON AVE STE 200 | ||||||||
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| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532102116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142483601 | ||||||||
| FaxNumber: | 4147449052 | ||||||||
| Practice Location | |||||||||
| Address1: | 6040 W LISBON AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532102116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142483601 | ||||||||
| FaxNumber: | 4147449052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | O'BOYLE | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4142483601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | B.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 52D0973993 | WI | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.