Provider Demographics
NPI:1215055256
Name:ELITE CLINICAL LABORATORY, INC
Entity type:Organization
Organization Name:ELITE CLINICAL LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-316-7764
Mailing Address - Street 1:3600 S GESSNER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5149
Mailing Address - Country:US
Mailing Address - Phone:281-617-7586
Mailing Address - Fax:
Practice Address - Street 1:3600 S GESSNER RD STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5149
Practice Address - Country:US
Practice Address - Phone:281-617-7586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159772601Medicaid
TXCL8530Medicare ID - Type Unspecified