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General NPI Number Information
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NPI Number | 1477548105
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Entity Type | Organization
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Legal Business Name | PATHOLOGY SERVICES, P.C.
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 1115 S WILLOW ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-6082
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Country | US
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Telephone | 308-532-4700
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Fax | 308-534-0534
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Provider Business Mailing Address
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Address Line | PO BOX 1289
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City | NORTH PLATTE
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State | NE
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Zip | 69103-1289
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Country | US
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Telephone | 308-532-4700
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Fax | 308-534-0534
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DIANNA J BROUILLETTE
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Credential |
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Telephone | 308-532-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 28D1016662
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License Number State | NE
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