Healthcare Provider Details

I. General information

NPI: 1073709069
Provider Name (Legal Business Name): CLINICAL DIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 RAILROAD ST
ELKO NV
89801-3831
US

IV. Provider business mailing address

845 RAILROAD ST
ELKO NV
89801-3831
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-3770
  • Fax: 775-753-3772
Mailing address:
  • Phone: 775-753-3770
  • Fax: 775-753-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TROY EDEN
Title or Position: OWNER
Credential: PA-C
Phone: 775-753-3770