Provider Demographics
NPI:1457002933
Name:EDWARDS ELITE LABS EXPRESS
Entity Type:Organization
Organization Name:EDWARDS ELITE LABS EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:TANYE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-209-6437
Mailing Address - Street 1:2000 E LAMAR BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006
Mailing Address - Country:US
Mailing Address - Phone:972-209-6437
Mailing Address - Fax:
Practice Address - Street 1:2000 E LAMAR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006
Practice Address - Country:US
Practice Address - Phone:972-209-6437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service