Provider Demographics
NPI:1639577091
Name:SPECIALTY DRUG TESTING, LLC
Entity Type:Organization
Organization Name:SPECIALTY DRUG TESTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUITT
Authorized Official - Suffix:
Authorized Official - Credentials:MT,(ASCP)
Authorized Official - Phone:318-410-9900
Mailing Address - Street 1:1300 FINKS HIDEAWAY RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2804
Mailing Address - Country:US
Mailing Address - Phone:318-410-9900
Mailing Address - Fax:318-410-9727
Practice Address - Street 1:1300 FINKS HIDEAWAY RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2804
Practice Address - Country:US
Practice Address - Phone:318-410-9900
Practice Address - Fax:318-410-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19D2087059291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory