Provider Demographics
NPI:1568696185
Name:CAPITAL TOXICOLOGY, LLC
Entity Type:Organization
Organization Name:CAPITAL TOXICOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. LABORATORY OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-610-9955
Mailing Address - Street 1:9417 BRODIE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5602
Mailing Address - Country:US
Mailing Address - Phone:512-610-9955
Mailing Address - Fax:512-610-9977
Practice Address - Street 1:9417 BRODIE LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5602
Practice Address - Country:US
Practice Address - Phone:512-610-9955
Practice Address - Fax:512-610-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1099976OtherCLIA