29D1080149 CLIA NUMBER - GREAT BASIN IMAGING

Laboratory Demographics

  • CLIA Code: 29D1080149
  • Facility Name: GREAT BASIN IMAGING
  • Facility Address: 2874 N CARSON ST STE 112
    CARSON CITY, NV
    ZIP 89706
  • Facility Phone: 775 445-8155
  • Facility Type: Other - O/P IMAGING CENTER
  • Facility Type: Waiver
  • Lab Director: DANIEL KIRKHAM
  • NPI Number: 1053883520
  • Taxonomy: 133V00000X - Dietitian, Registered

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CLIA Record

Field Name Field Value
CLIA Number 29D1080149
LAB Type Other - O/P IMAGING CENTER
Facility Name GREAT BASIN IMAGING
Street 2874 N CARSON ST STE 112
City CARSON CITY
State NV
ZIP 89706
Phone 775 445-8155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/14/2024
Certificate Expiration Date 2/13/2026
Facility Type Other - O/P IMAGING CENTER
Lab Director DANIEL KIRKHAM

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This page was last updated on: 9/29/2025