Provider Demographics
NPI:1093097636
Name:ELITE MEDICAL LABORATORIES, LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL LABORATORIES, LLC
Other - Org Name:ELITE HEMATOPATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-303-5796
Mailing Address - Street 1:3250 NE 1ST AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3250 NE 1ST AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4191
Practice Address - Country:US
Practice Address - Phone:305-303-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800026282291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFV207AMedicare PIN