Provider Demographics
NPI:1265846695
Name:LEHIGH VALLEY TOXICOLOGY LLC
Entity Type:Organization
Organization Name:LEHIGH VALLEY TOXICOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-566-2075
Mailing Address - Street 1:2550 BRODHEAD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8922
Mailing Address - Country:US
Mailing Address - Phone:267-566-2075
Mailing Address - Fax:215-253-4110
Practice Address - Street 1:2550 BRODHEAD RD STE 202
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8922
Practice Address - Country:US
Practice Address - Phone:267-566-2075
Practice Address - Fax:215-253-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00549889Medicaid
AK1695812Medicaid
SCL00722Medicaid
GA003226322AMedicaid
OK201003690Medicaid
LA2506790Medicaid
IN300028759Medicaid
NJ0642894Medicaid
PA102980871Medicaid
OH0193241Medicaid
WI100094814Medicaid
WA2150156Medicaid
MO700019461Medicaid
AZ098233Medicaid
CA19120K5DMedicaid
TNQ053862Medicaid