Provider Demographics
NPI:1073709069
Name:CLINICAL DIAGNOSTIC SERVICES, LLC
Entity Type:Organization
Organization Name:CLINICAL DIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:775-753-3770
Mailing Address - Street 1:845 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3831
Mailing Address - Country:US
Mailing Address - Phone:775-753-3770
Mailing Address - Fax:775-753-3772
Practice Address - Street 1:845 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3831
Practice Address - Country:US
Practice Address - Phone:775-753-3770
Practice Address - Fax:775-753-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center