Provider Demographics
NPI:1972971265
Name:QUALITOX LABORATORIES, LLC
Entity Type:Organization
Organization Name:QUALITOX LABORATORIES, LLC
Other - Org Name:THREE RIVERS DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-458-5431
Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1005
Practice Address - Country:US
Practice Address - Phone:412-458-5431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA34652291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA34652OtherPENNSYLVANIA BUREAU OF LABORATORIES ID NUMBER
8373057OtherCAP
PA1031359010001Medicaid
PA39D2105280OtherCLIA
PA26669OtherCOLA