Provider Demographics
NPI:1598750226
Name:PATHOLOGY SERVICES, P.C.
Entity Type:Organization
Organization Name:PATHOLOGY SERVICES, P.C.
Other - Org Name:PHYSICIANS OFFICE BUILDING LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROUILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-532-4700
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-1289
Mailing Address - Country:US
Mailing Address - Phone:308-532-4700
Mailing Address - Fax:308-534-0534
Practice Address - Street 1:611 W FRANCIS ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0614
Practice Address - Country:US
Practice Address - Phone:308-534-7489
Practice Address - Fax:308-534-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28D0898615291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098263Medicare ID - Type Unspecified
SD5580030Medicaid
CO98000912Medicaid
NE=========22Medicaid
NE01957OtherBLUE CROSS BLUE SHIELD