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General NPI Number Information
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NPI Number | 1942503412
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Entity Type | Organization
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Legal Business Name | ELITE CLINICAL LABORATORY LLC
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 1917 ASHLAND ST STE 120
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City | HOUSTON
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State | TX
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Zip | 77008-3907
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Country | US
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Telephone | 832-485-7155
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Fax | 832-436-1739
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Provider Business Mailing Address
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Address Line | 1800 ST JAMES PL STE 400
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City | HOUSTON
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State | TX
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Zip | 77056
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Country | US
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Telephone | 832-485-7155
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Fax | 832-436-1739
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Authorized Official
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Title or Position | OPERATIONS COORDINATOR
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Name | MS. MICHELE LEVY POCHE
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Credential |
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Telephone | 832-485-7155
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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 | 45D1061571
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License Number State | TX
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