MEDICARE: GBS DIAGNOSTIC SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number	:	1780275867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBS DIAGNOSTIC SERVICES PLLC

Provider Business Mailing Address
First Line	:	8528 DAVIS BLVD STE 134
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8302
Country	:	US
Telephone Number	:	469-528-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	6121 N STATE HIGHWAY STE 225
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-2265
Country	:	US
Telephone Number	:	469-528-1169
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHELLE GOTTLIEB
Credential	:
Telephone Number	:	469-528-1169

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	10/03/2022

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