Healthcare Provider Details

I. General information

NPI: 1750923553
Provider Name (Legal Business Name): PRECISION SKIN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2019
Last Update Date: 10/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 W 7TH ST
CHANUTE KS
66720-2505
US

IV. Provider business mailing address

805 NEW HAMPSHIRE ST STE C
LAWRENCE KS
66044-2774
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-4815
  • Fax: 785-749-3612
Mailing address:
  • Phone: 816-294-6156
  • Fax: 785-749-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE CUSICK
Title or Position: VP OPERATIONS
Credential:
Phone: 816-294-6156