Provider Demographics
NPI:1295822807
Name:PRIZM MEDICAL INC
Entity Type:Organization
Organization Name:PRIZM MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KUHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-955-9818
Mailing Address - Street 1:1991 HYDE PARK ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3600
Mailing Address - Country:US
Mailing Address - Phone:941-955-9818
Mailing Address - Fax:
Practice Address - Street 1:1991 HYDE PARK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3600
Practice Address - Country:US
Practice Address - Phone:941-955-9818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82917174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9134Medicare ID - Type UnspecifiedMEDICARE GROUP
FL06205XMedicare ID - Type Unspecified
FLA90502Medicare UPIN