Provider Demographics
NPI:1902422850
Name:PRECIOUS JEWELS MEDICAL & HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PRECIOUS JEWELS MEDICAL & HEALTH SERVICES, LLC
Other - Org Name:PRECIOUS JEWELS MEDICAL LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:SHANEKA
Authorized Official - Last Name:PETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-830-7075
Mailing Address - Street 1:401 WESTERN LN STE B
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7953
Mailing Address - Country:US
Mailing Address - Phone:803-834-7075
Mailing Address - Fax:
Practice Address - Street 1:401 WESTERN LN STE B
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7953
Practice Address - Country:US
Practice Address - Phone:803-830-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty