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General NPI Number Information
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NPI Number | 1376116111
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Entity Type | Organization
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Legal Business Name | ELITE BIOMEDICAL LAB SERVICE
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 15202 NW 147TH DR STE 600
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City | ALACHUA
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State | FL
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Zip | 32615-5333
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Country | US
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Telephone | 386-588-3230
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Fax | 888-480-7977
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Provider Business Mailing Address
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Address Line | 15202 NW 147TH DR STE 600
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City | ALACHUA
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State | FL
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Zip | 32615-5333
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Country | US
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Telephone | 386-588-3230
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Fax | 888-480-7977
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARJILLIAN WILLIAMS
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Credential | BS,MT
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Telephone | 386-965-0313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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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