MEDICARE: MEDSAN, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	247ZC0005X	Clinical Laboratory Director (Non-physician)
2	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician
3	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician
4	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1912617903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSAN, INC.

Provider Business Mailing Address
First Line	:	3360 SCHERER DR N STE B
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-1009
Country	:	US
Telephone Number	:	727-699-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	3360 SCHERER DR N STE B
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-1009
Country	:	US
Telephone Number	:	727-699-2777
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. JONATHAN BRENNER
Credential	:	PHD
Telephone Number	:	727-699-2777

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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