=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851697858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILL COUNTRY TOXICOLOGY, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2011
-----------------------------------------------------
Last Update Date | 10/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7909 FREDERICKSBURG RD. SUITE 150
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-614-1117
-----------------------------------------------------
Fax | 210-614-1121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7909 FREDERICKSBURG RD. SUITE 150
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-614-1117
-----------------------------------------------------
Fax | 210-614-1121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. WILLIAM W WHITE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-614-1117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 45D2018765
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------