29D2134201 CLIA NUMBER - INTERMOUNTAIN HEALTHCARE - CENTENNIAL

Laboratory Demographics

CLIA Number: 29D2134201

Facility Name: INTERMOUNTAIN HEALTHCARE - CENTENNIAL

Facility Address:
6170 N DURANGO DR STE 130
LAS VEGAS, NV
ZIP 89149
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Facility Phone Number: 702 940-1550

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477701183

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	29D2134201
LAB Type	Physician Office
Facility Name	INTERMOUNTAIN HEALTHCARE - CENTENNIAL
Street	6170 N DURANGO DR STE 130
City	LAS VEGAS
State	NV
ZIP	89149
Phone	702 940-1550
CertificateType	4
CertificateEffectiveDate	7/27/2023
CertificateExpirationDate	7/26/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024