Provider Demographics
NPI:1083232789
Name:MEDICAL LABORATORY SERVICES OF NEVADA, LLC
Entity Type:Organization
Organization Name:MEDICAL LABORATORY SERVICES OF NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:/OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-384-2238
Mailing Address - Street 1:2725 S JONES BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2725 S JONES BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5605
Practice Address - Country:US
Practice Address - Phone:702-384-2238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory