1053650135 NPI number — QUALITY TOXICOLOGY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053650135 NPI number — QUALITY TOXICOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY TOXICOLOGY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053650135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4726 SHAVANO OAK STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78249-4029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-463-9191
Provider Business Mailing Address Fax Number:
210-463-9190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4726 SHAVANO OAK
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78249-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-463-9191
Provider Business Practice Location Address Fax Number:
210-463-9190
Provider Enumeration Date:
02/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TRIPP
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
210-463-9195

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 338461201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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