Healthcare Provider Details

I. General information

NPI: 1083945984
Provider Name (Legal Business Name): PB HEALTHCARE SVCS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CYPRESS POINT PKWY SUITE A3
PALM COAST FL
32164-2500
US

IV. Provider business mailing address

50 CYPRESS POINT PKWY SUITE A3
PALM COAST FL
32164-2500
US

V. Phone/Fax

Practice location:
  • Phone: 386-445-0977
  • Fax: 386-445-0579
Mailing address:
  • Phone: 386-445-0977
  • Fax: 386-445-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN16698
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME101528
License Number StateFL

VIII. Authorized Official

Name: DR. PARMINDER S MAHAL
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 386-445-0977