Provider Demographics
NPI:1467419549
Name:PHYCON MEDICAL SCIENCES INC
Entity Type:Organization
Organization Name:PHYCON MEDICAL SCIENCES INC
Other - Org Name:PHYCON DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KLERSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-985-5818
Mailing Address - Street 1:635 GILLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3821
Mailing Address - Country:US
Mailing Address - Phone:813-985-5818
Mailing Address - Fax:813-985-1571
Practice Address - Street 1:13325 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1161
Practice Address - Country:US
Practice Address - Phone:813-985-5818
Practice Address - Fax:813-985-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1745Medicare ID - Type Unspecified