Provider Demographics
NPI:1295701480
Name:NEVADA HISTOLOGY, INC.
Entity type:Organization
Organization Name:NEVADA HISTOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-746-3400
Mailing Address - Street 1:1350 STARDUST ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4264
Mailing Address - Country:US
Mailing Address - Phone:775-747-2211
Mailing Address - Fax:775-746-3411
Practice Address - Street 1:1350 STARDUST ST
Practice Address - Street 2:SUITE D
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4264
Practice Address - Country:US
Practice Address - Phone:775-747-2211
Practice Address - Fax:775-746-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1512LIC-5291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG44897OtherMANSON
NVXPY068120OtherMEDICAL
NVF63457Medicare UPIN
NVV9L0008062Medicare ID - Type Unspecified
NVE80897Medicare UPIN
NVD66160Medicare UPIN
NVF26183Medicare UPIN
NVI29101Medicare UPIN
NVG44897OtherMANSON
NVA47387Medicare UPIN