MEDICARE: PRECISION HEALTH AND DIAGNOSTIC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WC1500X	Community Health Registered Nurse
2	246RP1900X	Phlebotomy Technician
3	172A00000X	Driver
4	163W00000X	Registered Nurse
5	163WW0101X	Ambulatory Women's Health Care Registered Nurse
6	246Z00000X	Other Specialist/Technologist
7	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1194695932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION HEALTH AND DIAGNOSTIC LLC

Provider Business Mailing Address
First Line	:	4818 WASHINGTON BLVD STE 4013
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1829
Country	:	US
Telephone Number	:	314-948-4602
Fax Number	:	314-590-2759

Provider Business Practice Location Address
First Line	:	4818 WASHINGTON BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1829
Country	:	US
Telephone Number	:	314-948-4602
Fax Number	:	314-590-2757

Authorized Official
Title or Position	:	REGISTER NURSE/ LAB DIRECTOR
Name	:	JASSMA DAVIS
Credential	:	ASN
Telephone Number	:	314-948-4602

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	12/10/2025

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