Provider Demographics
NPI:1952790206
Name:SELECT TOXICOLOGY LAB (STL), LLC
Entity Type:Organization
Organization Name:SELECT TOXICOLOGY LAB (STL), LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-653-9198
Mailing Address - Street 1:PO BOX 13029
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3029
Mailing Address - Country:US
Mailing Address - Phone:336-510-1120
Mailing Address - Fax:
Practice Address - Street 1:1051 BILL BUYCK BLVD
Practice Address - Street 2:STE A
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1528122678OtherCLIA