Provider Demographics
NPI:1609944735
Name:BOARD OF REGENTS NEVADA SYSTEM OF HIGHER EDUCATION
Entity Type:Organization
Organization Name:BOARD OF REGENTS NEVADA SYSTEM OF HIGHER EDUCATION
Other - Org Name:NEVADA STATE PUBLIC HEALTH LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:775-688-1335
Mailing Address - Street 1:1660 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-0703
Mailing Address - Country:US
Mailing Address - Phone:775-688-1335
Mailing Address - Fax:775-688-1460
Practice Address - Street 1:1660 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-0703
Practice Address - Country:US
Practice Address - Phone:775-688-1335
Practice Address - Fax:775-688-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1479LIC-6291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004316004Medicaid