Provider Demographics
NPI:1285890723
Name:ASSURANCE DRUG TESTING LABORATORIES LLC
Entity type:Organization
Organization Name:ASSURANCE DRUG TESTING LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:414-248-3601
Mailing Address - Street 1:6040 W LISBON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2116
Mailing Address - Country:US
Mailing Address - Phone:414-248-3601
Mailing Address - Fax:414-744-9052
Practice Address - Street 1:6040 W LISBON AVE STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2116
Practice Address - Country:US
Practice Address - Phone:414-248-3601
Practice Address - Fax:414-744-9052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52D0973993291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory