Provider Demographics
NPI:1649804436
Name:INDEPENDENT DRUG TESTING AND FORENSIC SERVICES
Entity type:Organization
Organization Name:INDEPENDENT DRUG TESTING AND FORENSIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-255-1190
Mailing Address - Street 1:4800 140TH AVENUE
Mailing Address - Street 2:STE 102
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5708
Mailing Address - Country:US
Mailing Address - Phone:505-255-1190
Mailing Address - Fax:505-345-5799
Practice Address - Street 1:4213 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1103
Practice Address - Country:US
Practice Address - Phone:505-255-1190
Practice Address - Fax:505-345-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory