Provider Demographics
NPI:1013301159
Name:PRECISION ANALYSIS LAB, LLC
Entity type:Organization
Organization Name:PRECISION ANALYSIS LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-849-8783
Mailing Address - Street 1:101 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-471-5995
Mailing Address - Fax:
Practice Address - Street 1:101 17TH STREET
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-471-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18D2091975291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory