Provider Demographics
NPI:1770717449
Name:PRECISE CLINICAL NEUROSCIENCE SPECIALISTS
Entity type:Organization
Organization Name:PRECISE CLINICAL NEUROSCIENCE SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAVESKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-550-7536
Mailing Address - Street 1:PO BOX 306603
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6603
Mailing Address - Country:US
Mailing Address - Phone:601-420-7010
Mailing Address - Fax:601-420-5811
Practice Address - Street 1:3531 LAKELAND DR STE 1060
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8016
Practice Address - Country:US
Practice Address - Phone:601-420-7010
Practice Address - Fax:601-402-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS178342084N0400X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A44788Medicare UPIN