Healthcare Provider Details

I. General information

NPI: 1942717210
Provider Name (Legal Business Name): PHYSICIAN'S MANAGED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14910 N DALE MABRY HWY # 340147
TAMPA FL
33694-0147
US

IV. Provider business mailing address

PO BOX 340147
TAMPA FL
33694-0147
US

V. Phone/Fax

Practice location:
  • Phone: 813-562-6319
  • Fax: 813-961-0392
Mailing address:
  • Phone: 813-562-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TRISH JOHNS
Title or Position: MANAGER
Credential: NRCMA
Phone: 813-961-0392