29D2134653 CLIA NUMBER - ACTIVATE HEALTHCARE-IBEW LOCAL 357 CLINIC

Laboratory Demographics

CLIA Number: 29D2134653

Facility Name: ACTIVATE HEALTHCARE-IBEW LOCAL 357 CLINIC

Facility Address:
51 N PECOS RD STE 110
LAS VEGAS, NV
ZIP 89101
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Facility Phone Number: 702 437-0227

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1356865455

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	29D2134653
LAB Type	Physician Office
Facility Name	ACTIVATE HEALTHCARE-IBEW LOCAL 357 CLINIC
Street	51 N PECOS RD STE 110
City	LAS VEGAS
State	NV
ZIP	89101
Phone	702 437-0227
CertificateType	4
CertificateEffectiveDate	8/7/2023
CertificateExpirationDate	8/6/2025
FacilityType	Waiver

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