Provider Demographics
NPI:1396166351
Name:PRECISION PROSTHETICS LLC
Entity type:Organization
Organization Name:PRECISION PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-878-6945
Mailing Address - Street 1:5526 SCOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BENTONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39040-9310
Mailing Address - Country:US
Mailing Address - Phone:601-941-3238
Mailing Address - Fax:
Practice Address - Street 1:1403 PLAZA DR
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2719
Practice Address - Country:US
Practice Address - Phone:662-746-8331
Practice Address - Fax:662-673-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
7176150001Medicare NSC