Provider Demographics
NPI:1508827924
Name:MARDINI PATHOLOGY, LTD
Entity Type:Organization
Organization Name:MARDINI PATHOLOGY, LTD
Other - Org Name:GREAT BASIN PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-753-5845
Mailing Address - Street 1:1250 LAMOILLE HWY
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4396
Mailing Address - Country:US
Mailing Address - Phone:775-753-5845
Mailing Address - Fax:
Practice Address - Street 1:1250 LAMOILLE HWY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4396
Practice Address - Country:US
Practice Address - Phone:775-753-5845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
NV29D0966835291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002004030Medicaid
NV002004030Medicaid
2200028180Medicare PIN
NV101203Medicare PIN