Healthcare Provider Details

I. General information

NPI: 1780275867
Provider Name (Legal Business Name): GBS DIAGNOSTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N STATE HIGHWAY STE 225
IRVING TX
75038-2265
US

IV. Provider business mailing address

8528 DAVIS BLVD STE 134
NORTH RICHLAND HILLS TX
76182-8302
US

V. Phone/Fax

Practice location:
  • Phone: 469-528-1169
  • Fax:
Mailing address:
  • Phone: 469-528-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GOTTLIEB
Title or Position: MANAGER
Credential:
Phone: 469-528-1169