Provider Demographics
NPI:1003229089
Name:ESA TOXICOLOGY LLC
Entity Type:Organization
Organization Name:ESA TOXICOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-877-0600
Mailing Address - Street 1:2100 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3673
Mailing Address - Country:US
Mailing Address - Phone:713-877-0600
Mailing Address - Fax:713-877-0601
Practice Address - Street 1:2100 WEST LOOP SOUTH
Practice Address - Street 2:SUITE 1200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77477-3673
Practice Address - Country:US
Practice Address - Phone:713-877-0600
Practice Address - Fax:713-877-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory