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General NPI Number Information
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NPI Number | 1710282686
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Entity Type | Organization
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Legal Business Name | ST MICHAELS LABS LAS VEGAS INC
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 2865 SIENA HEIGHTS DR SUITE 200
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City | HENDERSON
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State | NV
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Zip | 89052-4167
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Country | US
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Telephone | 702-824-9655
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Fax | 702-889-4213
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Provider Business Mailing Address
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Address Line | PO BOX 924109 SUITE 200
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City | HOUSTON
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State | TX
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Zip | 77292-4109
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Country | US
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Telephone | 713-586-6778
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Fax | 713-586-6752
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Authorized Official
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Title or Position | CREDENTIALING ASSISITANT
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Name | JO ANN JOHNSON
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Credential |
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Telephone | 713-586-6778
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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 | 29D2008291
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License Number State | NV
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