Provider Demographics
NPI:1275292294
Name:ELITE BIO REFERENCE LABORATORY LLC
Entity type:Organization
Organization Name:ELITE BIO REFERENCE LABORATORY LLC
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:281-617-7586
Mailing Address - Street 1:7827 N DALE MABRY HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3222
Mailing Address - Country:US
Mailing Address - Phone:281-795-5603
Mailing Address - Fax:
Practice Address - Street 1:7827 N DALE MABRY HWY STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3222
Practice Address - Country:US
Practice Address - Phone:281-617-7586
Practice Address - Fax:281-466-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory