Provider Demographics
NPI:1376730945
Name:CONSOLIDATED LABORATORY SERVICES, INC
Entity Type:Organization
Organization Name:CONSOLIDATED LABORATORY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOJANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-650-0439
Mailing Address - Street 1:4275 BURNHAM AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-8212
Mailing Address - Country:US
Mailing Address - Phone:702-650-0439
Mailing Address - Fax:702-650-9687
Practice Address - Street 1:1670 E CALVADA BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048
Practice Address - Country:US
Practice Address - Phone:702-650-0439
Practice Address - Fax:702-650-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1304312501261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1952382400OtherNPI