Provider Demographics
NPI:1043769078
Name:EMPLOYMENT TESTING SERVICES
Entity Type:Organization
Organization Name:EMPLOYMENT TESTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-685-6442
Mailing Address - Street 1:3805 SOUTH DOUGLAS HWY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718
Mailing Address - Country:US
Mailing Address - Phone:307-685-6442
Mailing Address - Fax:307-685-6404
Practice Address - Street 1:3805 SOUTH DOUGLAS HWY
Practice Address - Street 2:UNIT 1
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718
Practice Address - Country:US
Practice Address - Phone:307-685-6442
Practice Address - Fax:307-685-6404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPLOYMENT TESTING SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory