=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417069170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST COAST MEDICAL CRYSTAL RIVER, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 05/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4131 MARINER BLVD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-2469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-666-1703
-----------------------------------------------------
Fax | 352-666-1366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5288
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34611-5288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-666-1703
-----------------------------------------------------
Fax | 352-666-1366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | SYED S HASAN
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 352-666-1703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME75485
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------