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General NPI Number Information
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NPI Number | 1760874077
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Entity Type | Organization
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Legal Business Name | RENEW TOXICOLOGY
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Dates
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Enumeration Date | 02/23/2015
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 5009 S HULEN ST
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City | FORT WORTH
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State | TX
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Zip | 76132-1967
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Country | US
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Telephone | 817-717-7605
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 W INTERSTATE 20 STE 202
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City | ARLINGTON
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State | TX
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Zip | 76017-1678
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Country | US
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Telephone | 817-717-7605
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | ALISON REEVES
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Credential |
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Telephone | 817-360-4829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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