Healthcare Provider Details

I. General information

NPI: 1114244167
Provider Name (Legal Business Name): TOXICOLOGY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 FRANKLIN ST
LA MARQUE TX
77568-6303
US

IV. Provider business mailing address

6910 BELLAIRE BLVD SUITE 12
HOUSTON TX
77074-3509
US

V. Phone/Fax

Practice location:
  • Phone: 409-935-3749
  • Fax: 409-935-1892
Mailing address:
  • Phone: 713-541-3218
  • Fax: 713-541-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number0000009
License Number StateTX

VIII. Authorized Official

Name: JOHNNY RAIA III
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-541-3218