Provider Demographics
NPI:1902678006
Name:ELITE MEDICAL LABORATORY LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RONNISHA
Authorized Official - Middle Name:SHAQUANA
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:779-475-1603
Mailing Address - Street 1:5435 EMERSON WAY STE 405A-B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1466
Mailing Address - Country:US
Mailing Address - Phone:317-827-0011
Mailing Address - Fax:
Practice Address - Street 1:5435 EMERSON WAY STE 405A-B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1466
Practice Address - Country:US
Practice Address - Phone:317-827-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty