MEDICARE: FENN SYSTEMS INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1063943942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FENN SYSTEMS INC.

Provider Business Mailing Address
First Line	:	5703 RED BUG LAKE RD
Second Line	:	SUITE 518
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4969
Country	:	US
Telephone Number	:	407-595-0146
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 WESTWOOD SQ
Second Line	:	SUITE C
City	:	OVIEDO
State	:	FL
Zip	:	32765-8849
Country	:	US
Telephone Number	:	407-595-0146
Fax Number	:

Authorized Official
Title or Position	:	DIRECOTR
Name	:	MR. TIM FENNELL
Credential	:
Telephone Number	:	407-595-0146

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	03/23/2017

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