Basic Information
| Provider Information | |||||||||
| NPI: | 1760782122 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PBS DIAGNOSTICS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9735 KINCEY AVE | ||||||||
| Address2: | SUITE 302A | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280789118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046603322 | ||||||||
| FaxNumber: | 7046603330 | ||||||||
| Practice Location | |||||||||
| Address1: | 9735 KINCEY AVE | ||||||||
| Address2: | SUITE 302A | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280789118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046603322 | ||||||||
| FaxNumber: | 7046603330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2010 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | MICHAELS | ||||||||
| AuthorizedOfficialFirstName: | SAM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | INCORPORATOR | ||||||||
| AuthorizedOfficialTelephone: | 7046603322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 34D2015092 | NC | N | Laboratories | Clinical Medical Laboratory | 207ZP0101X | 34D2015092 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.