29D2191357 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE - SPRING VALLEY

Laboratory Demographics

  • CLIA Code: 29D2191357
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE - SPRING VALLEY
  • Facility Address: 4001 S DECATUR BLVD
    LAS VEGAS, NV
    ZIP 89103
  • Facility Phone: 725 224-6967
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TRACY J. WAKEFIELD
  • NPI Number: 1285257667
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 29D2191357
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE - SPRING VALLEY
Street 4001 S DECATUR BLVD
City LAS VEGAS
State NV
ZIP 89103
Phone 725 224-6967
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2024
Certificate Expiration Date 8/24/2026
Facility Type Physician Office
Lab Director TRACY J. WAKEFIELD

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This page was last updated on: 6/4/2025