MEDICARE: QUALITY FORENSIC TOXICOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1053841023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY FORENSIC TOXICOLOGY LLC

Provider Business Mailing Address
First Line	:	4726 SHAVANO OAK STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4029
Country	:	US
Telephone Number	:	210-463-9191
Fax Number	:	210-463-9190

Provider Business Practice Location Address
First Line	:	4726 SHAVANO OAK STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4029
Country	:	US
Telephone Number	:	210-463-9191
Fax Number	:	210-463-9190

Authorized Official
Title or Position	:	CFO/COO
Name	:	MRS. REGINA L TRIPP
Credential	:
Telephone Number	:	210-463-9191

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	09/06/2022

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