Basic Information
Provider Information
NPI: 1679648273
EntityType: 2
ReplacementNPI:  
OrganizationName: PATHOLOGY BIOMEDICAL CONSULTING, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: PBC CONSULTING, INC.
OtherOrganizationType: 4
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2484 E RIVER RD
Address2:  
City: TUCSON
State: AZ
PostalCode: 857186522
CountryCode: US
TelephoneNumber: 5208882121
FaxNumber: 5208884850
Practice Location
Address1: 2484 E RIVER RD
Address2:  
City: TUCSON
State: AZ
PostalCode: 857186522
CountryCode: US
TelephoneNumber: 5208882121
FaxNumber: 5208884850
Other Information
ProviderEnumerationDate: 11/21/2006
LastUpdateDate: 10/19/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SAGERMAN
AuthorizedOfficialFirstName: PAUL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 5208882121
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
291U00000X AZY LaboratoriesClinical Medical Laboratory 

No ID Information.


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