Healthcare Provider Details

I. General information

NPI: 1912968405
Provider Name (Legal Business Name): SILVER STATE CLINICAL LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 W FLAMINGO RD UNIT 104
LAS VEGAS NV
89103-2234
US

IV. Provider business mailing address

6330 W FLAMINGO RD UNIT 104
LAS VEGAS NV
89103-2234
US

V. Phone/Fax

Practice location:
  • Phone: 702-761-9176
  • Fax: 702-331-9984
Mailing address:
  • Phone: 702-761-9176
  • Fax: 702-457-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number4426LIC-0
License Number StateNV

VIII. Authorized Official

Name: ALLEN MCKAY
Title or Position: CO-OWNER
Credential:
Phone: 702-761-9176