Provider Demographics
NPI:1376116111
Name:ELITE BIOMEDICAL LAB SERVICE
Entity Type:Organization
Organization Name:ELITE BIOMEDICAL LAB SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARJILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MT
Authorized Official - Phone:386-965-0313
Mailing Address - Street 1:15202 NW 147TH DR STE 600
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-5333
Mailing Address - Country:US
Mailing Address - Phone:386-588-3230
Mailing Address - Fax:888-480-7977
Practice Address - Street 1:15202 NW 147TH DR STE 600
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5333
Practice Address - Country:US
Practice Address - Phone:386-588-3230
Practice Address - Fax:888-480-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2166575OtherCLIA