Provider Demographics
NPI:1417262643
Name:NEVADA MEDICAL CHOICE CORP
Entity Type:Organization
Organization Name:NEVADA MEDICAL CHOICE CORP
Other - Org Name:CLARIPATH LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROBYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-437-2824
Mailing Address - Street 1:4075 S DURANGO DR
Mailing Address - Street 2:STE 111-26
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4163
Mailing Address - Country:US
Mailing Address - Phone:877-437-2824
Mailing Address - Fax:
Practice Address - Street 1:985 BROAD ST
Practice Address - Street 2:STE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1286
Practice Address - Country:US
Practice Address - Phone:877-437-2824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11D1047326291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory