MEDICARE: PRECISION HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	58049572401	UT
2	227800000X	Certified Respiratory Therapist	112389-5701	UT
3	227800000X	Certified Respiratory Therapist	49883845701	UT
4	235Z00000X	Speech-Language Pathologist	1123864102	UT
5	302F00000X	Exclusive Provider Organization	44447	UT
6	1041C0700X	Clinical Social Worker	2679333501	UT
7	174400000X	Specialist	357997-1205	UT
8	174400000X	Specialist	357997-8905	UT
9	332B00000X	Durable Medical Equipment & Medical Supplies	60051260151	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00291261	OTHER	UT	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103007426101	OTHER	UT	IHC PROVIDER ID NUMBER
2	73301	OTHER	UT	PEHP PROVIDER NUMBER
3	QM0000064662	OTHER	UT	ALTIUS PROVIDER NUMBER
4	781709	OTHER	UT	DESERT MUTUAL BENEFITS AD
5	44447000001001	OTHER	UT	BLUE CROSS PROVIDER NUMBE
7	61101	OTHER	UT	HUMANA

General Provider Information

NPI Number	:	1336249572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	4885 S 900 E STE 107
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-3905
Country	:	US
Telephone Number	:	801-266-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	4885 S 900 E STE 107
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-3905
Country	:	US
Telephone Number	:	801-266-0399
Fax Number	:

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	MR. STUART B CANNON
Credential	:	BS MBA
Telephone Number	:	801-266-0399

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	10/31/2008

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Directions to “PRECISION HEALTH SERVICES, INC. ” Practice Location

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