Healthcare Provider Details

I. General information

NPI: 1376730945
Provider Name (Legal Business Name): CONSOLIDATED LABORATORY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E CALVADA BLVD SUITE 600
PAHRUMP NV
89048
US

IV. Provider business mailing address

4275 BURNHAM AVE STE 325
LAS VEGAS NV
89119-8212
US

V. Phone/Fax

Practice location:
  • Phone: 702-650-0439
  • Fax: 702-650-9687
Mailing address:
  • Phone: 702-650-0439
  • Fax: 702-650-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number1304312501
License Number StateNV

VIII. Authorized Official

Name: ALEXANDER STOJANOFF
Title or Position: DIRECTOR
Credential: PHD
Phone: 702-650-0439