1093091936 NPI number — WEST VIRGINIA DRUG TESTING LABORATORIES INC

Table of content: (NPI 1093091936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093091936 NPI number — WEST VIRGINIA DRUG TESTING LABORATORIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST VIRGINIA DRUG TESTING LABORATORIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093091936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1385
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26102-1385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-422-3915
Provider Business Mailing Address Fax Number:
304-485-4466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 MAIN ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONCEVERTE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24970-1259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-647-1389
Provider Business Practice Location Address Fax Number:
304-647-1397
Provider Enumeration Date:
10/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
304-422-8570

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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