MEDICARE: MEDLAB 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	29D1106338	NV

General Provider Information

NPI Number	:	1679804843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDLAB LLC

Provider Business Mailing Address
First Line	:	2860 S JONES BLVD
Second Line	:	2
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5308
Country	:	US
Telephone Number	:	702-834-7600
Fax Number	:	702-834-7602

Provider Business Practice Location Address
First Line	:	2860 S JONES BLVD
Second Line	:	2
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5308
Country	:	US
Telephone Number	:	702-834-7600
Fax Number	:	702-834-7602

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. NAVDEEP SINGH GILL
Credential	:	M.D.
Telephone Number	:	702-834-7600

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	07/08/2010

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