Provider Demographics
NPI:1841649738
Name:SOUTHERN NEVADA HEALTH DISTRICT CLINICAL LABORATORY
Entity type:Organization
Organization Name:SOUTHERN NEVADA HEALTH DISTRICT CLINICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-759-0636
Mailing Address - Street 1:280 S DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2936
Mailing Address - Country:US
Mailing Address - Phone:702-759-1000
Mailing Address - Fax:702-759-1444
Practice Address - Street 1:280 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2936
Practice Address - Country:US
Practice Address - Phone:702-759-1000
Practice Address - Fax:702-759-1444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN NEVADA HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7426-EXL-3291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory