Provider Demographics
NPI:1699035691
Name:ASSURED TOXICOLOGY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ASSURED TOXICOLOGY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-832-0734
Mailing Address - Street 1:4201 VINELAND RD
Mailing Address - Street 2:SUITE I-12
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7486
Mailing Address - Country:US
Mailing Address - Phone:321-710-3405
Mailing Address - Fax:321-413-0255
Practice Address - Street 1:4201 VINELAND RD
Practice Address - Street 2:SUITE I-12
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-7486
Practice Address - Country:US
Practice Address - Phone:321-710-3405
Practice Address - Fax:321-413-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory