Provider Demographics
NPI:1659538411
Name:INTERNAL MEDICINE ASSOCIATES LABORATORY
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-464-7127
Mailing Address - Street 1:6301 MOUNTAIN VISTA ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2364
Mailing Address - Country:US
Mailing Address - Phone:702-792-4336
Mailing Address - Fax:702-385-4823
Practice Address - Street 1:3121 S MARYLAND PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2307
Practice Address - Country:US
Practice Address - Phone:702-369-1344
Practice Address - Fax:702-369-6550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNAL MEDICINE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29D0538607291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506353Medicaid
NV100506353Medicaid