Provider Demographics
NPI:1457651952
Name:LABORATORY SERVICES OF NEVADA, LLC
Entity Type:Organization
Organization Name:LABORATORY SERVICES OF NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTHURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-857-3648
Mailing Address - Street 1:3376 S EASTERN AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3397
Mailing Address - Country:US
Mailing Address - Phone:702-684-6000
Mailing Address - Fax:702-684-6002
Practice Address - Street 1:3376 S EASTERN AVE STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3397
Practice Address - Country:US
Practice Address - Phone:702-684-6000
Practice Address - Fax:702-684-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5562LIC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
29D1094377OtherCLIA NUMBER
NV5562LICOtherDIVISION OF HEALTH LICENSE