MEDICARE: DIAGNOSTIC CENTER OF MEDICINE

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	1456LIC4	NV

General Provider Information

NPI Number	:	1962476036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC CENTER OF MEDICINE

Provider Business Mailing Address
First Line	:	3012 S DURANGO DR
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9186
Country	:	US
Telephone Number	:	702-366-1655
Fax Number	:	702-385-4955

Provider Business Practice Location Address
First Line	:	3012 S DURANGO DR
Second Line	:	SUITE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9186
Country	:	US
Telephone Number	:	702-366-0640
Fax Number	:	702-366-9075

Authorized Official
Title or Position	:	CEO
Name	:	LAWRENCE M ALLEN
Credential	:	MD
Telephone Number	:	702-366-0640

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	08/22/2020

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Directions to “DIAGNOSTIC CENTER OF MEDICINE ” Practice Location

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