Provider Demographics
NPI:1871841130
Name:LABORATORY SERVICES OF AMERICA LLC
Entity type:Organization
Organization Name:LABORATORY SERVICES OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KOTHURU
Authorized Official - Suffix:
Authorized Official - Credentials:MSHSA
Authorized Official - Phone:702-685-6777
Mailing Address - Street 1:3376 S EASTERN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3380
Mailing Address - Country:US
Mailing Address - Phone:702-685-6777
Mailing Address - Fax:702-946-1401
Practice Address - Street 1:3376 S EASTERN AVE
Practice Address - Street 2:STE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3380
Practice Address - Country:US
Practice Address - Phone:702-685-6777
Practice Address - Fax:702-946-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGW168AOtherMEDICARE PTAN