Provider Demographics
NPI:1679804843
Name:MEDLAB LLC
Entity Type:Organization
Organization Name:MEDLAB LLC
Other - Org Name:MEDLAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-834-7600
Mailing Address - Street 1:2860 S JONES BLVD
Mailing Address - Street 2:2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5308
Mailing Address - Country:US
Mailing Address - Phone:702-834-7600
Mailing Address - Fax:702-834-7602
Practice Address - Street 1:2860 S JONES BLVD
Practice Address - Street 2:2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5308
Practice Address - Country:US
Practice Address - Phone:702-834-7600
Practice Address - Fax:702-834-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29D1106338291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory