29D2207609 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE-N LAS VEGAS

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Laboratory Demographics

CLIA Number: 29D2207609

Facility Name: CENTERWELL SENIOR PRIMARY CARE-N LAS VEGAS

Facility Address:
2335 EAST LAKE MEAD BLVD
N LAS VEGAS, NV
ZIP 89030
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Facility Phone Number: 702 577-1910

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1265196893

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	29D2207609
LAB Type	Physician Office
Facility Name	CENTERWELL SENIOR PRIMARY CARE-N LAS VEGAS
Street	2335 EAST LAKE MEAD BLVD
City	N LAS VEGAS
State	NV
ZIP	89030
Phone	702 577-1910
CertificateType	4
CertificateEffectiveDate	12/29/2022
CertificateExpirationDate	12/28/2024
FacilityType	Waiver

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