Provider Demographics
NPI:1821092297
Name:REGIONAL TOXICOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:REGIONAL TOXICOLOGY SERVICES, LLC
Other - Org Name:CORDANT HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR OF CREDENTIALING/ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-304-7602
Mailing Address - Street 1:PO BOX 830525
Mailing Address - Street 2:#OWC 28
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0525
Mailing Address - Country:US
Mailing Address - Phone:508-304-7602
Mailing Address - Fax:508-304-7602
Practice Address - Street 1:2617 E L ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98421-2205
Practice Address - Country:US
Practice Address - Phone:253-552-1551
Practice Address - Fax:253-295-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D0891660291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022527Medicaid
WA7115405Medicaid
MT0421243Medicaid
CA1821092297Medicaid