Provider Demographics
NPI:1144488941
Name:PRECISION DIAGNOSTIC INC
Entity type:Organization
Organization Name:PRECISION DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN-A-SUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-344-7566
Mailing Address - Street 1:540 NW UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2279
Mailing Address - Country:US
Mailing Address - Phone:772-344-7566
Mailing Address - Fax:
Practice Address - Street 1:540 NW UNIVERSITY BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2279
Practice Address - Country:US
Practice Address - Phone:772-344-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)