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General NPI Number Information
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NPI Number | 1003214784
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Entity Type | Organization
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Legal Business Name | FSBS ENTERPRISES, INC.
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 9142 SHENANDOAH RUN
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-5455
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Country | US
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Telephone | 618-803-9230
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Fax |
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Provider Business Mailing Address
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Address Line | 9142 SHENANDOAH RUN
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-5455
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Country | US
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Telephone | 618-803-9230
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JASON M PETTY
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Credential |
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Telephone | 618-803-9230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS5043
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License Number State | FL
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