Provider Demographics
NPI:1861987083
Name:ELITE DIAGNOSTICS INC
Entity type:Organization
Organization Name:ELITE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLAMOTHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-896-0805
Mailing Address - Street 1:1853 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4711
Mailing Address - Country:US
Mailing Address - Phone:314-485-1327
Mailing Address - Fax:314-485-1227
Practice Address - Street 1:1853 CRAIG RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4711
Practice Address - Country:US
Practice Address - Phone:314-485-1327
Practice Address - Fax:314-485-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory