Provider Demographics
NPI:1750923553
Name:PRECISION SKIN CARE, LLC
Entity type:Organization
Organization Name:PRECISION SKIN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-294-6156
Mailing Address - Street 1:805 NEW HAMPSHIRE ST STE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2774
Mailing Address - Country:US
Mailing Address - Phone:816-294-6156
Mailing Address - Fax:785-749-3612
Practice Address - Street 1:1709 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2505
Practice Address - Country:US
Practice Address - Phone:620-431-4815
Practice Address - Fax:785-749-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty