Provider Demographics
NPI:1871691246
Name:PRECISION DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:PRECISION DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:BS MBA
Authorized Official - Phone:801-266-0399
Mailing Address - Street 1:4885 S 900 E STE 107
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3905
Mailing Address - Country:US
Mailing Address - Phone:801-266-0399
Mailing Address - Fax:801-266-0421
Practice Address - Street 1:4885 S 900 E STE 107
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-3905
Practice Address - Country:US
Practice Address - Phone:801-266-0399
Practice Address - Fax:801-266-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT44618291U00000X
UT4611291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000064662OtherALITUS
UTP00059272OtherRR MEDICARE
UT73047OtherPEHP
UTP00059272Medicare PIN
UTP00059272OtherRR MEDICARE