MEDICARE: TELELAB

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	2084P0800X	Psychiatry Physician
3	251S00000X	Community/Behavioral Health Agency
4	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV20201850927	OTHER	NV	BUSINESS LICENSE

General Provider Information

NPI Number	:	1639788599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELELAB

Provider Business Mailing Address
First Line	:	7881 W CHARLESTON BLVD STE 230
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8327
Country	:	US
Telephone Number	:	702-508-2153
Fax Number	:	702-508-2435

Provider Business Practice Location Address
First Line	:	6889 W CHARLESTON BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1644
Country	:	US
Telephone Number	:	702-779-3582
Fax Number	:	702-508-2435

Authorized Official
Title or Position	:	OWNER
Name	:	ALICIA WALKER
Credential	:
Telephone Number	:	702-901-9081

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	03/11/2021

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Directions to “TELELAB ” Practice Location

Language	Start Address	Practice Location

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