Provider Demographics
NPI:1811598899
Name:PRECISION DIAGNOSTIX LLC
Entity Type:Organization
Organization Name:PRECISION DIAGNOSTIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-563-4640
Mailing Address - Street 1:917 SE LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3810
Mailing Address - Country:US
Mailing Address - Phone:904-563-4640
Mailing Address - Fax:
Practice Address - Street 1:917 SE LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3810
Practice Address - Country:US
Practice Address - Phone:904-563-4640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
10D2189524OtherCLIA