29D2192479 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE - FREMONT STREET

Laboratory Demographics

  • CLIA Code: 29D2192479
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE - FREMONT STREET
  • Facility Address: 1766 E CHARLESTON BLVD
    LAS VEGAS, NV
    ZIP 89104
  • Facility Phone: 702 843-2440
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TRACY WAKEFIELD
  • NPI Number: 1083237465
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 29D2192479
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE - FREMONT STREET
Street 1766 E CHARLESTON BLVD
City LAS VEGAS
State NV
ZIP 89104
Phone 702 843-2440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Physician Office
Lab Director TRACY WAKEFIELD

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