MEDICARE: AMERICAN SPECIALTY LAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	8032LIC-0	NV

General Provider Information

NPI Number	:	1063968675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN SPECIALTY LAB LLC

Provider Business Mailing Address
First Line	:	7251 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7251 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1632
Country	:	US
Telephone Number	:	702-233-1791
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NICHOLAS PRESCOTT
Credential	:
Telephone Number	:	702-233-1791

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	02/03/2026

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