10D2166575 CLIA NUMBER - ELITE BIOMEDICAL LAB SERVICE, LLC

Laboratory Demographics

CLIA Number: 10D2166575

Facility Name: ELITE BIOMEDICAL LAB SERVICE, LLC

Facility Address:
15202 NW 147TH DR SUITE 600
ALACHUA, FL
ZIP 32615
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Facility Phone Number: 386 965-0313

Facility Type: Other - PATIENT SERV CTR

Certificate Type: Waiver

NPI Number: 1376116111

Taxonomy: 246RP1900X - Technician, Pathology

CLIA Record

Field Name	Field Value
CLIA Number	10D2166575
LAB Type	Other - PATIENT SERV CTR
Facility Name	ELITE BIOMEDICAL LAB SERVICE, LLC
Street	15202 NW 147TH DR SUITE 600
City	ALACHUA
State	FL
ZIP	32615
Phone	386 965-0313
CertificateType	4
CertificateEffectiveDate	5/21/2023
CertificateExpirationDate	5/20/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024