Provider Demographics
NPI:1831647403
Name:WEST VIRGINIA DRUG TESTING LABORATORIES,
Entity Type:Organization
Organization Name:WEST VIRGINIA DRUG TESTING LABORATORIES,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:JESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-487-8485
Mailing Address - Street 1:108 S WALKER ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2745
Mailing Address - Country:US
Mailing Address - Phone:304-487-8485
Mailing Address - Fax:
Practice Address - Street 1:108 S WALKER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2745
Practice Address - Country:US
Practice Address - Phone:304-487-8485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51D1086270291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory