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General NPI Number Information
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NPI Number | 1144049495
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Entity Type | Organization
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Legal Business Name | ELITE-DIAGNOSTIC LLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1201 HIGHWAY 49 S STE 5B
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City | RICHLAND
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State | MS
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Zip | 39218-9438
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Country | US
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Telephone | 601-665-0360
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 HIGHWAY 49 S STE 5B
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City | RICHLAND
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State | MS
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Zip | 39218-9438
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Country | US
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Telephone | 601-665-0360
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | AKIMMIE LYNN LEWIS
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Credential | PHLEBOTOMIST
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Telephone | 601-665-0360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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