Provider Demographics
NPI:1538745138
Name:ELITE DIAGNOSTICS SOLUTIONS LLC
Entity type:Organization
Organization Name:ELITE DIAGNOSTICS SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY ANN
Authorized Official - Middle Name:O
Authorized Official - Last Name:PREDDIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-225-5224
Mailing Address - Street 1:7857 W SAMPLE RD STE 136
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4748
Mailing Address - Country:US
Mailing Address - Phone:954-225-5224
Mailing Address - Fax:
Practice Address - Street 1:7857 W SAMPLE RD STE 136
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4748
Practice Address - Country:US
Practice Address - Phone:954-225-5224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory