Organization
NEVADA STAT LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY RICHARDSON (OWNER)
(702) 701-9260
Entity
Organization
Contact information
Practice address
2675 S JONES BLVD STE 111, LAS VEGAS, NV 89146-5607
(702) 701-9260
(702) 701-9234
Mailing address
2675 S JONES BLVD STE 111, LAS VEGAS, NV 89146-5607
(702) 701-9260
(702) 701-9234
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29D2149533
CLIA
NV
Enumeration date
06/19/2018
Last updated
06/19/2018
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