1972142909 NPI number — PRECISION HEALTH SOLUTIONS, LLC

Table of content: AHMAD ABU LIMON MD (NPI 1881080406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972142909 NPI number — PRECISION HEALTH SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION HEALTH SOLUTIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972142909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9675 4TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33702-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-235-0886
Provider Business Mailing Address Fax Number:
833-288-9397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9675 4TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33702-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-235-0886
Provider Business Practice Location Address Fax Number:
833-288-9397
Provider Enumeration Date:
12/20/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORDONEZ
Authorized Official First Name:
BRIGITHY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL LABORATORY TECHNOLOGIST
Authorized Official Telephone Number:
941-228-6656

Provider Taxonomy Codes

  • Taxonomy code: 156F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 107748500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".