MEDICARE: EMS TOXICOLOGY

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

General Provider Information

NPI Number	:	1083004493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMS TOXICOLOGY

Provider Business Mailing Address
First Line	:	6171 MCLEOD DR STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4410
Country	:	US
Telephone Number	:	949-467-9213
Fax Number	:

Provider Business Practice Location Address
First Line	:	6171 MCLEOD DR STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4410
Country	:	US
Telephone Number	:	949-467-9213
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. STEVE FENNELLY
Credential	:
Telephone Number	:	949-467-9213

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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Directions to “EMS TOXICOLOGY ” Practice Location

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