Provider Demographics
NPI:1962893586
Name:DISCOVERY TOX, LLC
Entity type:Organization
Organization Name:DISCOVERY TOX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-831-1675
Mailing Address - Street 1:11620 AIRWAY BLVD
Mailing Address - Street 2:UNIT 102 SUITE B
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3632
Mailing Address - Country:US
Mailing Address - Phone:682-831-1675
Mailing Address - Fax:682-831-1396
Practice Address - Street 1:11620 AIRWAY BLVD
Practice Address - Street 2:UNIT 102, SUITE B
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3632
Practice Address - Country:US
Practice Address - Phone:682-831-1675
Practice Address - Fax:682-831-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2089741291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory