Provider Demographics
NPI:1619258464
Name:PRECISION LITHOTRIPSY LLC
Entity Type:Organization
Organization Name:PRECISION LITHOTRIPSY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:BAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-403-4078
Mailing Address - Street 1:PO BOX 237592
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32923-7592
Mailing Address - Country:US
Mailing Address - Phone:321-636-0535
Mailing Address - Fax:321-636-1975
Practice Address - Street 1:3490 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-8724
Practice Address - Country:US
Practice Address - Phone:321-636-0535
Practice Address - Fax:321-636-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy