Provider Demographics
NPI:1073985727
Name:TOXUSA LABS LLC
Entity Type:Organization
Organization Name:TOXUSA LABS LLC
Other - Org Name:CONNECTDX LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-703-2272
Mailing Address - Street 1:236 W EDISON RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3184
Mailing Address - Country:US
Mailing Address - Phone:574-703-2272
Mailing Address - Fax:574-343-1505
Practice Address - Street 1:236 W EDISON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3184
Practice Address - Country:US
Practice Address - Phone:574-703-2272
Practice Address - Fax:574-343-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15D2102246291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory