Healthcare Provider Details

I. General information

NPI: 1649120015
Provider Name (Legal Business Name): ELITE LAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W TROY ST STE B
DOTHAN AL
36303-4455
US

IV. Provider business mailing address

212 W TROY ST STE B
DOTHAN AL
36303-4455
US

V. Phone/Fax

Practice location:
  • Phone: 256-592-6628
  • Fax:
Mailing address:
  • Phone: 256-592-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ASELA MOYA
Title or Position: MANAGING MEMBER
Credential:
Phone: 256-592-6628