MEDICARE: GRYFFIN'S TALON LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1093316994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRYFFIN'S TALON LLC

Provider Business Mailing Address
First Line	:	5601 CORPORATE WAY STE 108
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2041
Country	:	US
Telephone Number	:	561-420-0010
Fax Number	:	561-223-3036

Provider Business Practice Location Address
First Line	:	5601 CORPORATE WAY STE 108
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2041
Country	:	US
Telephone Number	:	561-420-0010
Fax Number	:	561-420-0010

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHRISTIAN MAYER
Credential	:
Telephone Number	:	561-420-0010

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	10/19/2021

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