Healthcare Provider Details

I. General information

NPI: 1295701480
Provider Name (Legal Business Name): NEVADA HISTOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 STARDUST ST SUITE D
RENO NV
89503-4264
US

IV. Provider business mailing address

1350 STARDUST ST SUITE D
RENO NV
89503-4264
US

V. Phone/Fax

Practice location:
  • Phone: 775-747-2211
  • Fax: 775-746-3411
Mailing address:
  • Phone: 775-747-2211
  • Fax: 775-746-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1512LIC-5
License Number StateNV

VIII. Authorized Official

Name: MR. MICHAEL BLUM
Title or Position: GENERAL MANAGER
Credential:
Phone: 775-746-3400