Provider Demographics
NPI:1386984011
Name:LWD INC
Entity type:Organization
Organization Name:LWD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CORT
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-751-8613
Mailing Address - Street 1:1210 E BASIN AVE
Mailing Address - Street 2:UNITE 3
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-2101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 E BASIN AVE
Practice Address - Street 2:UNITE 3
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-2101
Practice Address - Country:US
Practice Address - Phone:775-751-8613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory