MEDICARE: SILVER STATE CLINICAL LABORATORY 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
2	291U00000X	Clinical Medical Laboratory	4426LIC-0	NV

General Provider Information

NPI Number	:	1912968405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER STATE CLINICAL LABORATORY LLC

Provider Business Mailing Address
First Line	:	6330 W FLAMINGO RD UNIT 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2234
Country	:	US
Telephone Number	:	702-761-9176
Fax Number	:	702-457-5228

Provider Business Practice Location Address
First Line	:	6330 W FLAMINGO RD UNIT 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2234
Country	:	US
Telephone Number	:	702-761-9176
Fax Number	:	702-331-9984

Authorized Official
Title or Position	:	CO-OWNER
Name	:	ALLEN MCKAY
Credential	:
Telephone Number	:	702-761-9176

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	08/31/2022

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