1376730945 NPI number — CONSOLIDATED LABORATORY SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376730945 NPI number — CONSOLIDATED LABORATORY SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSOLIDATED LABORATORY SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376730945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4275 BURNHAM AVE STE 325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89119-8212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-650-0439
Provider Business Mailing Address Fax Number:
702-650-9687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1670 E CALVADA BLVD
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-650-0439
Provider Business Practice Location Address Fax Number:
702-650-9687
Provider Enumeration Date:
09/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOJANOFF
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
702-650-0439

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  1304312501 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1952382400 . This is a "NPI" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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