Provider Demographics
NPI:1053650135
Name:QUALITY TOXICOLOGY, LLC
Entity Type:Organization
Organization Name:QUALITY TOXICOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-463-9195
Mailing Address - Street 1:4726 SHAVANO OAK STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4029
Mailing Address - Country:US
Mailing Address - Phone:210-463-9191
Mailing Address - Fax:210-463-9190
Practice Address - Street 1:4726 SHAVANO OAK
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4033
Practice Address - Country:US
Practice Address - Phone:210-463-9191
Practice Address - Fax:210-463-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338461201Medicaid