Provider Demographics
NPI:1932274040
Name:PHYSICIAN LABORATORY SERVICES, INC
Entity type:Organization
Organization Name:PHYSICIAN LABORATORY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-587-1261
Mailing Address - Street 1:931 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 3220
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6911
Mailing Address - Country:US
Mailing Address - Phone:406-587-1261
Mailing Address - Fax:406-587-3928
Practice Address - Street 1:931 HIGHLAND BLVD
Practice Address - Street 2:SUITE 3220
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6911
Practice Address - Country:US
Practice Address - Phone:406-587-1261
Practice Address - Fax:406-587-3928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTCS1430Medicare ID - Type UnspecifiedRAILRAOD MEDICARE GROUP #