Provider Demographics
NPI:1821427097
Name:SELECT TOXICOLOGY LABS, LLC
Entity Type:Organization
Organization Name:SELECT TOXICOLOGY LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-505-6100
Mailing Address - Street 1:1051 BILL BUYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-9242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1051 BILL BUYCK BLVD
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-9242
Practice Address - Country:US
Practice Address - Phone:803-505-6100
Practice Address - Fax:803-505-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory