Provider Demographics
NPI:1811384019
Name:PRECISION CLINICAL LABORATORY PCL
Entity Type:Organization
Organization Name:PRECISION CLINICAL LABORATORY PCL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENGESHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-856-7177
Mailing Address - Street 1:11275 E MISSISSIPPI AVE STE 2W1
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2828
Mailing Address - Country:US
Mailing Address - Phone:303-856-7177
Mailing Address - Fax:303-856-3924
Practice Address - Street 1:11275 E MISSISSIPPI AVE STE 2W1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2828
Practice Address - Country:US
Practice Address - Phone:303-856-7177
Practice Address - Fax:303-856-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57320250Medicaid