Organization
CAPITAL TOXICOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY T. WISE (V.P. LABORATORY OPERATIONS)
(512) 610-9955
Entity
Organization
Contact information
Practice address
9417 BRODIE LN, AUSTIN, TX 78748-5602
(512) 610-9955
(512) 610-9977
Mailing address
9417 BRODIE LN, AUSTIN, TX 78748-5602
(512) 610-9955
(512) 610-9977
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D1099976
CLIA
TX
Enumeration date
05/11/2009
Last updated
08/13/2009
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