Provider Demographics
NPI:1740594605
Name:INTENSIVE CARE INC
Entity Type:Organization
Organization Name:INTENSIVE CARE INC
Other - Org Name:ENID CLINICAL LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLBOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-579-5935
Mailing Address - Street 1:4012 S RAINBOW BLVD
Mailing Address - Street 2:STE K320
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2010
Mailing Address - Country:US
Mailing Address - Phone:800-579-5935
Mailing Address - Fax:
Practice Address - Street 1:3517 W OWEN K GARRIOTT RD STE 5
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4953
Practice Address - Country:US
Practice Address - Phone:800-579-5935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37D0472525291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory