Provider Demographics
NPI:1053775965
Name:LUX LABORATORIES LLC
Entity type:Organization
Organization Name:LUX LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-401-4483
Mailing Address - Street 1:2851 EL CAMINO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4266
Mailing Address - Country:US
Mailing Address - Phone:702-380-3210
Mailing Address - Fax:702-380-3212
Practice Address - Street 1:2851 EL CAMINO AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4266
Practice Address - Country:US
Practice Address - Phone:702-380-3210
Practice Address - Fax:702-380-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161197177291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV50561OtherNORIDIAN