Provider Demographics
NPI:1669614491
Name:PRECISION DIAGNOSTIC OF LAKE WORTH, LLC
Entity type:Organization
Organization Name:PRECISION DIAGNOSTIC OF LAKE WORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN-A-SUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-317-0078
Mailing Address - Street 1:1722 S CONGRESS AVE
Mailing Address - Street 2:1722A
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2140
Mailing Address - Country:US
Mailing Address - Phone:561-623-8346
Mailing Address - Fax:561-623-8347
Practice Address - Street 1:1722 S CONGRESS AVE
Practice Address - Street 2:1722A
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2140
Practice Address - Country:US
Practice Address - Phone:561-623-8346
Practice Address - Fax:561-623-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFILE # 8803261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)