| Organization Name: | PHYSICIANS SERVICE LABORATORY |
| NPI Number: | 1770667586 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BLAINE L MONTGOMERY (SUPERVISING RADIOLOGIST) |
| Mailing Address: | 5101 E Florence Ave 2 Bell |
| State: | CA US |
| Postal Code: | 902013801 |
| Phone Number: | 3235601862 |
| Fax Number: | 3235607580 |
| NPI Enumeration Date: | 10/25/2006 |
| NPI Last Update Date: | 04/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | A28710 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |