Provider Demographics
NPI:1619944253
Name:PRECISION DIAGNOSTIC SERVICES INC
Entity type:Organization
Organization Name:PRECISION DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & SPECIAL PROJECT MGR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-572-5970
Mailing Address - Street 1:536 OLD HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1969
Mailing Address - Country:US
Mailing Address - Phone:877-550-2949
Mailing Address - Fax:336-217-0802
Practice Address - Street 1:1531 32ND AVE S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5911
Practice Address - Country:US
Practice Address - Phone:701-234-9667
Practice Address - Fax:701-271-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18606Medicaid
IA1619944253Medicaid
ND18606Medicaid
NDN715787Medicare PIN
NDN714170Medicare PIN
NDN711922Medicare PIN