Healthcare Provider Details

I. General information

NPI: 1700800133
Provider Name (Legal Business Name): PKC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 AVENUE K SE
WINTER HAVEN FL
33880-4125
US

IV. Provider business mailing address

490 AVENUE K SE
WINTER HAVEN FL
33880-4125
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-8353
  • Fax: 863-299-0334
Mailing address:
  • Phone: 863-294-8353
  • Fax: 863-299-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS1699
License Number StateFL

VIII. Authorized Official

Name: MR. PATRICK JOSEPH CONLON
Title or Position: OWNER/PRESIDENT
Credential: BC-HIS
Phone: 863-698-1822