Organization
FYZAMEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER PENROD (BILLER)
(305) 907-4175
Entity
Organization
Contact information
Practice address
7209 CURRY FORD RD STE B, ORLANDO, FL 32822-5809
(407) 501-8563
(512) 532-0923
Mailing address
142 BLACKSTONE CREEK RD, GROVELAND, FL 34736-3621
(407) 668-5525
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2150190
CLIA
FL
Enumeration date
10/27/2017
Last updated
12/18/2020
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