Provider Demographics
NPI:1649663048
Name:QUICK TOX SCREEN 1 LLC
Entity type:Organization
Organization Name:QUICK TOX SCREEN 1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-327-3141
Mailing Address - Street 1:PO BOX 847721
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7721
Mailing Address - Country:US
Mailing Address - Phone:844-327-3141
Mailing Address - Fax:844-622-0933
Practice Address - Street 1:2920 MOTLEY DR
Practice Address - Street 2:SUITE 180
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3471
Practice Address - Country:US
Practice Address - Phone:844-327-3141
Practice Address - Fax:844-622-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2043717OtherCLIA