Healthcare Provider Details

I. General information

NPI: 1306490883
Provider Name (Legal Business Name): PRECISE TELEHEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 OLD VIRGINIA STREET
URBANNA VA
23175
US

IV. Provider business mailing address

22 W. PADONIA RD STE C241
TIMONIUM MD
21093
US

V. Phone/Fax

Practice location:
  • Phone: 203-524-9871
  • Fax: 678-609-1300
Mailing address:
  • Phone: 203-524-9871
  • Fax: 678-609-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KEROUAC
Title or Position: PRESIDENT
Credential:
Phone: 203-524-9871