Provider Demographics
NPI:1669706040
Name:DAVIS GROUP, LTD.
Entity type:Organization
Organization Name:DAVIS GROUP, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-778-2694
Mailing Address - Street 1:8440 W LAKE MEAD BLVD
Mailing Address - Street 2:104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7648
Mailing Address - Country:US
Mailing Address - Phone:702-778-2694
Mailing Address - Fax:
Practice Address - Street 1:8440 W LAKE MEAD BLVD
Practice Address - Street 2:104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-778-2694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVIS GROUP, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-01
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10713291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory