Provider Demographics
NPI:1417640178
Name:VENI-PHLEB ELITE LLC
Entity Type:Organization
Organization Name:VENI-PHLEB ELITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:260-217-3187
Mailing Address - Street 1:3229 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-2114
Mailing Address - Country:US
Mailing Address - Phone:317-548-9074
Mailing Address - Fax:
Practice Address - Street 1:3229 W 52ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-2114
Practice Address - Country:US
Practice Address - Phone:260-217-3187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory