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General NPI Number Information
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NPI Number | 1538025689
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Entity Type | Organization
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Legal Business Name | IC LABS LLC
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Dates
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Enumeration Date | 01/02/2026
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 1730 W HORIZON RIDGE PKWY STE 100
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City | HENDERSON
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State | NV
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Zip | 89012-1000
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Country | US
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Telephone | 702-935-3136
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Fax | 702-263-9390
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Provider Business Mailing Address
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Address Line | 67 INCLINE VILLAGE CT
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City | HENDERSON
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State | NV
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Zip | 89074-0694
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Country | US
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Telephone | 702-203-7799
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Fax | 702-263-9390
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ISAAC FARRELL
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Credential |
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Telephone | 702-203-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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