Provider Demographics
NPI:1457531592
Name:UNITED DRUG TESTING LABORATORY INC
Entity Type:Organization
Organization Name:UNITED DRUG TESTING LABORATORY INC
Other - Org Name:US CRIME LAB
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:208-331-4097
Mailing Address - Street 1:1010 N. ORCHARD ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-331-4097
Mailing Address - Fax:208-331-4095
Practice Address - Street 1:1010 N. ORCHARD ST
Practice Address - Street 2:SUITE 8
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-331-4097
Practice Address - Fax:208-331-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID13D026723291U00000X
IDP947291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory