Provider Demographics
NPI:1376950667
Name:INTIRE TOX SCREEN
Entity Type:Organization
Organization Name:INTIRE TOX SCREEN
Other - Org Name:INTIRE DIAGNOSTIC LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELBOSQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-826-4294
Mailing Address - Street 1:517 N CARRIER PKWY STE H
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5464
Mailing Address - Country:US
Mailing Address - Phone:214-677-0639
Mailing Address - Fax:214-677-0532
Practice Address - Street 1:517 N CARRIER PKWY STE H
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5464
Practice Address - Country:US
Practice Address - Phone:214-677-0639
Practice Address - Fax:214-677-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory