Provider Demographics
NPI:1710282686
Name:ST MICHAELS LABS LAS VEGAS INC
Entity Type:Organization
Organization Name:ST MICHAELS LABS LAS VEGAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ASSISITANT
Authorized Official - Prefix:
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-586-6778
Mailing Address - Street 1:PO BOX 924109
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-4109
Mailing Address - Country:US
Mailing Address - Phone:713-586-6778
Mailing Address - Fax:713-586-6752
Practice Address - Street 1:2865 SIENA HEIGHTS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4167
Practice Address - Country:US
Practice Address - Phone:702-824-9655
Practice Address - Fax:702-889-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29D2008291291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory