Nevada Stat Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

NEVADA STAT LABORATORY

Practice address

2675 S Jones Blvd Ste 111
Las Vegas, NV 89146-5607

Phone

(702) 701-9260

Fax

(702) 701-9234

NPI assigned

Jun 19, 2018

Last updated

Jun 19, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anthony Richardson

Title

Owner

Phone

(702) 701-9260

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529366400000",
    "number": "1588158950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 S JONES BLVD STE 111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891465607",
            "telephone_number": "702-701-9260",
            "fax_number": "702-701-9234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 S JONES BLVD STE 111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891465607",
            "telephone_number": "702-701-9260",
            "fax_number": "702-701-9234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEVADA STAT LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-701-9260"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "29D2149533",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Clinical Medical Laboratory in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.