Provider Demographics
NPI:1275292294
Name:ELITE BIO REFERENCE LABORATORY LLC
Entity Type:Organization
Organization Name:ELITE BIO REFERENCE LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-795-5603
Mailing Address - Street 1:4502 CORTEZ RD W STE 302B
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3124
Mailing Address - Country:US
Mailing Address - Phone:281-795-5603
Mailing Address - Fax:
Practice Address - Street 1:4502 CORTEZ RD W STE 302B
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3124
Practice Address - Country:US
Practice Address - Phone:281-795-5603
Practice Address - Fax:281-466-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory