MEDICARE: PHYCON MEDICAL SCIENCES INC

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1467419549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYCON MEDICAL SCIENCES INC

Provider Business Mailing Address
First Line	:	635 GILLETTE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-3821
Country	:	US
Telephone Number	:	813-985-5818
Fax Number	:	813-985-1571

Provider Business Practice Location Address
First Line	:	13325 N 56TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-1161
Country	:	US
Telephone Number	:	813-985-5818
Fax Number	:	813-985-1571

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MR. PERRIN C KLERSY
Credential	:
Telephone Number	:	813-985-5818

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	08/22/2020

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Directions to “PHYCON MEDICAL SCIENCES INC ” Practice Location

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