Provider Demographics
NPI:1730816869
Name:PRECISION NEURO DIAGNOSTICS LLC
Entity type:Organization
Organization Name:PRECISION NEURO DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-248-9890
Mailing Address - Street 1:860654 S 3430 RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-7078
Mailing Address - Country:US
Mailing Address - Phone:979-248-9890
Mailing Address - Fax:
Practice Address - Street 1:860654 S 3430 RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-7078
Practice Address - Country:US
Practice Address - Phone:979-248-9890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty