Provider Demographics
NPI:1376152983
Name:SPORTS DRUG TESTING LABORATORY, LLC
Entity Type:Organization
Organization Name:SPORTS DRUG TESTING LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/CAO/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MONTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-994-9464
Mailing Address - Street 1:10644 S JORDAN GTWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4036
Mailing Address - Country:US
Mailing Address - Phone:801-994-9454
Mailing Address - Fax:801-994-9455
Practice Address - Street 1:10644 S JORDAN GTWY STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4036
Practice Address - Country:US
Practice Address - Phone:801-994-9454
Practice Address - Fax:801-994-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory