MEDICARE: E-LAB OF LAS VEGAS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1336957448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E-LAB OF LAS VEGAS, LLC

Provider Business Mailing Address
First Line	:	616 S 8TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-7005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2950 S RAINBOW BLVD STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6213
Country	:	US
Telephone Number	:	725-214-4367
Fax Number	:	725-214-4469

Authorized Official
Title or Position	:	OWNER
Name	:	LEONIDAS P FLANGAS
Credential	:
Telephone Number	:	702-217-1026

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	12/20/2024

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