Basic Information
| Provider Information | |||||||||
| NPI: | 1144628710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDCOMP TOX, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20203 MACHOST RD | ||||||||
| Address2: | |||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707917235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255708486 | ||||||||
| FaxNumber: | 2255708487 | ||||||||
| Practice Location | |||||||||
| Address1: | 20203 MACHOST RD | ||||||||
| Address2: | |||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707917235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255708486 | ||||||||
| FaxNumber: | 2255708487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2014 | ||||||||
| LastUpdateDate: | 12/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | BEASLEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/COO | ||||||||
| AuthorizedOfficialTelephone: | 2255708486 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.