Provider Demographics
NPI:1760782122
Name:PBS DIAGNOSTICS, P.C.
Entity Type:Organization
Organization Name:PBS DIAGNOSTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-660-3322
Mailing Address - Street 1:9735 KINCEY AVE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9118
Mailing Address - Country:US
Mailing Address - Phone:704-660-3322
Mailing Address - Fax:704-660-3330
Practice Address - Street 1:9735 KINCEY AVE
Practice Address - Street 2:SUITE 302A
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9118
Practice Address - Country:US
Practice Address - Phone:704-660-3322
Practice Address - Fax:704-660-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D2015092207ZP0101X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty