Provider Demographics
NPI:1316225956
Name:ESSENTIAL TESTING, LLC
Entity Type:Organization
Organization Name:ESSENTIAL TESTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-623-0623
Mailing Address - Street 1:1616 EASTPORT PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6128
Mailing Address - Country:US
Mailing Address - Phone:618-623-0623
Mailing Address - Fax:
Practice Address - Street 1:1616 EASTPORT PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-6128
Practice Address - Country:US
Practice Address - Phone:618-623-0623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory