Organization
PHYSICIANS SERVICE LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAINE L MONTGOMERY MD (SUPERVISING RADIOLOGIST)
(323) 560-1862
Entity
Organization
Contact information
Practice address
5101 E FLORENCE AVE, 2, BELL, CA 90201-3801
(323) 560-1862
(323) 560-7580
Mailing address
5101 E FLORENCE AVE, 2, BELL, CA 90201-3801
(323) 560-1862
(323) 560-7580
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A28710
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A287100
—
CA
01
—
222583422
BLUE SHIELD
CA
Enumeration date
10/25/2006
Last updated
04/04/2014
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