Healthcare Provider Details

I. General information

NPI: 1760782122
Provider Name (Legal Business Name): PBS DIAGNOSTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 KINCEY AVE SUITE 302A
HUNTERSVILLE NC
28078-9118
US

IV. Provider business mailing address

9735 KINCEY AVE SUITE 302A
HUNTERSVILLE NC
28078-9118
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-3322
  • Fax: 704-660-3330
Mailing address:
  • Phone: 704-660-3322
  • Fax: 704-660-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number34D2015092
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number34D2015092
License Number StateNC

VIII. Authorized Official

Name: DR. SAM M MICHAELS
Title or Position: INCORPORATOR
Credential:
Phone: 704-660-3322