Provider Demographics
NPI:1073909016
Name:DRUG TEST OF IDAHO LLC
Entity Type:Organization
Organization Name:DRUG TEST OF IDAHO LLC
Other - Org Name:GLOBAL DRUG TESTING LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-429-1445
Mailing Address - Street 1:921 S ORCHARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1992
Mailing Address - Country:US
Mailing Address - Phone:208-429-1445
Mailing Address - Fax:208-429-1705
Practice Address - Street 1:921 S ORCHARD ST STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1992
Practice Address - Country:US
Practice Address - Phone:208-429-1445
Practice Address - Fax:208-429-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory