Healthcare Provider Details

I. General information

NPI: 1750960415
Provider Name (Legal Business Name): LSA LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3376 S EASTERN AVE STE 110
LAS VEGAS NV
89169-3367
US

IV. Provider business mailing address

3376 S EASTERN AVE STE 110
LAS VEGAS NV
89169-3367
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-6777
  • Fax: 702-946-1401
Mailing address:
  • Phone: 702-685-6777
  • Fax: 702-946-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MCCONNELL
Title or Position: CFO
Credential:
Phone: 702-808-1187