Provider Demographics
NPI:1265486724
Name:PROFESSIONAL DIAGNOSTIC SERVICES, INC
Entity Type:Organization
Organization Name:PROFESSIONAL DIAGNOSTIC SERVICES, INC
Other - Org Name:PDS MEDICAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:UBELAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-241-9666
Mailing Address - Street 1:2601 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-4106
Mailing Address - Country:US
Mailing Address - Phone:785-856-0909
Mailing Address - Fax:785-371-4025
Practice Address - Street 1:2601 IOWA STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046
Practice Address - Country:US
Practice Address - Phone:785-856-0909
Practice Address - Fax:785-371-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS118076OtherBC/BS PROVIDER NUMBER
KS100445480AMedicaid