Provider Demographics
NPI:1083382592
Name:PRECISION LIFE SCIENCES LLC
Entity Type:Organization
Organization Name:PRECISION LIFE SCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-556-6628
Mailing Address - Street 1:4850 GOODMAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7906
Mailing Address - Country:US
Mailing Address - Phone:615-556-6628
Mailing Address - Fax:
Practice Address - Street 1:4850 GOODMAN RD STE 101
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7906
Practice Address - Country:US
Practice Address - Phone:615-556-6628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory