{
"Npi": {
"NPI": "1366820870",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PENTA STATE LLC",
"ParentOrgTIN": null,
"OrgName": "ELITE MEDICAL LABORATORY SOLUTIONS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1101 ALMA ST",
"SecondLineMailingAddress": "HUNTERWOOD MEDICAL BUILDING, SUITE 100",
"MailingAddressCityName": "TOMBALL",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77375-4554",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "844-867-8134",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1101 ALMA ST",
"SecondLinePracticeLocationAddress": "HUNTERWOOD MEDICAL BUILDING, SUITE 100",
"PracticeLocationAddressCityName": "TOMBALL",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77375-4554",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "646-592-1337",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/16/2015",
"LastUpdateDate": "02/06/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALSAAB",
"AuthorizedOfficialFirstName": "SAAD",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "646-592-1337",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "291U0000X",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}