Provider Demographics
NPI:1275838179
Name:PATHOLOGISTS BIOMEDICAL LABORATORIES PLLC
Entity Type:Organization
Organization Name:PATHOLOGISTS BIOMEDICAL LABORATORIES PLLC
Other - Org Name:PBM TARRANT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYSERT
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:214-818-9100
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:WADLEY TOWER, SUITE 261
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-818-9100
Mailing Address - Fax:214-818-9170
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 185
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-424-5350
Practice Address - Fax:817-424-5351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHOLOGISTS BIO-MEDICAL LABORATORIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-24
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty