Healthcare Provider Details

I. General information

NPI: 1114864782
Provider Name (Legal Business Name): ELEPHAS LABORATORIES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ERDMAN PL STE 100
MADISON WI
53717-2101
US

IV. Provider business mailing address

1 ERDMAN PL STE 100
MADISON WI
53717-2101
US

V. Phone/Fax

Practice location:
  • Phone: 608-622-7954
  • Fax:
Mailing address:
  • Phone: 608-622-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA ROUTH
Title or Position: LABORATORY DIRECTOR
Credential: MD
Phone: 602-481-9650