=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285827907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FNS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2007
-----------------------------------------------------
Last Update Date | 07/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4562 HUNTING TRL
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-3535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-881-1893
-----------------------------------------------------
Fax | 561-207-7818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4562 HUNTING TRL
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-3535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-881-1893
-----------------------------------------------------
Fax | 561-207-7818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | DR. SHAHZAD Y KHAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-843-5285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME93216
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME93216
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | ME93216
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------