Provider Demographics
NPI:1558766501
Name:NATIONAL INSTITUTE OF TOXICOLOGY, PLLC
Entity Type:Organization
Organization Name:NATIONAL INSTITUTE OF TOXICOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-648-8550
Mailing Address - Street 1:956 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3747
Mailing Address - Country:US
Mailing Address - Phone:336-648-8550
Mailing Address - Fax:336-648-8551
Practice Address - Street 1:956 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3747
Practice Address - Country:US
Practice Address - Phone:336-648-8550
Practice Address - Fax:336-648-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-01
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36016208D00000X, 291U00000X, 291U00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01953Medicaid
NC34D22080208OtherCLIA CERTIFICATE
NC34D2085270OtherCLIA
NC70121OtherBLUE CROSS BLUE SHIELD
NC205233OtherNORTH CAROLINA MEDICAL BOARD