Provider Demographics
NPI:1336249572
Name:PRECISION HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:PRECISION HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:BS MBA
Authorized Official - Phone:801-266-0399
Mailing Address - Street 1:4885 S 900 E STE 107
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3905
Mailing Address - Country:US
Mailing Address - Phone:801-266-0399
Mailing Address - Fax:
Practice Address - Street 1:4885 S 900 E STE 107
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-3905
Practice Address - Country:US
Practice Address - Phone:801-266-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT26793335011041C0700X
UT357997-1205174400000X
UT357997-8905174400000X
UT58049572401225100000X
UT112389-5701227800000X
UT49883845701227800000X
UT1123864102235Z00000X
UT44447302F00000X
UT60051260151332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT103007426101OtherIHC PROVIDER ID NUMBER
UT73301OtherPEHP PROVIDER NUMBER
UTQM0000064662OtherALTIUS PROVIDER NUMBER
UT781709OtherDESERT MUTUAL BENEFITS AD
UT44447000001001OtherBLUE CROSS PROVIDER NUMBE
UTP00291261OtherRR MEDICARE
UT61101OtherHUMANA
UT=========001Medicaid
UT=========001Medicaid
UT4913840001Medicare NSC