Provider Demographics
NPI:1912968405
Name:SILVER STATE CLINICAL LABORATORY LLC
Entity Type:Organization
Organization Name:SILVER STATE CLINICAL LABORATORY LLC
Other - Org Name:SILVER STATE CLINICAL LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-761-9176
Mailing Address - Street 1:6330 W FLAMINGO RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2234
Mailing Address - Country:US
Mailing Address - Phone:702-761-9176
Mailing Address - Fax:702-457-5228
Practice Address - Street 1:6330 W FLAMINGO RD UNIT 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2234
Practice Address - Country:US
Practice Address - Phone:702-761-9176
Practice Address - Fax:702-331-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-01
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4426LIC-0291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102091Medicare PIN