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General NPI Number Information
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NPI Number | 1902422850
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Entity Type | Organization
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Legal Business Name | PRECIOUS JEWELS MEDICAL & HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 401 WESTERN LN STE B
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City | IRMO
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State | SC
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Zip | 29063-7953
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Country | US
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Telephone | 803-830-9095
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Fax |
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Provider Business Mailing Address
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Address Line | 401 WESTERN LN STE B
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City | IRMO
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State | SC
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Zip | 29063-7953
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Country | US
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Telephone | 803-834-7075
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Fax |
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Authorized Official
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Title or Position | MEDICAL OFFICER
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Name | NIKITA SHANEKA PETE
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Credential |
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Telephone | 803-830-7075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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