Healthcare Provider Details

I. General information

NPI: 1912617903
Provider Name (Legal Business Name): MEDSAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 SCHERER DR N STE B
SAINT PETERSBURG FL
33716-1009
US

IV. Provider business mailing address

3360 SCHERER DR N STE B
SAINT PETERSBURG FL
33716-1009
US

V. Phone/Fax

Practice location:
  • Phone: 727-699-2777
  • Fax:
Mailing address:
  • Phone: 727-699-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN BRENNER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 727-699-2777