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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEGARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-877-1267
Mailing Address - Street 1:4152 30TH AVE S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8403
Mailing Address - Country:US
Mailing Address - Phone:701-234-9667
Mailing Address - Fax:701-271-9260
Practice Address - Street 1:4152 30TH AVE SO
Practice Address - Street 2:SUITE 103
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
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:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN002412100Medicaid
IA1619944253Medicaid
ND18606Medicaid
NDN715787Medicare PIN
NDN714170Medicare PIN
NDN711922Medicare PIN