Basic Information
| Provider Information | |||||||||
| NPI: | 1235324054 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRECISION HEALTH CARE SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PHS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 4A JUDGES ROAD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284053655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107916767 | ||||||||
| FaxNumber: | 9107916890 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 CENTER ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285465708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102382744 | ||||||||
| FaxNumber: | 9102382755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2007 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | BEEKMAN | ||||||||
| AuthorizedOfficialFirstName: | ERINN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8883111254 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8303567P | 05 | NC | MEDICAID | 8303567D | 05 | NC | MEDICAID | 3410033 | 05 | NC | MEDICAID | 8303567 | 05 | NC | MEDICAID | 8303567Q | 05 | NC | MEDICAID |