=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447761267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMARILLO PRIMARY CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2017
-----------------------------------------------------
Last Update Date | 10/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1915 S COULTER ST
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-352-5400
-----------------------------------------------------
Fax | 806-352-8555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1915 S COULTER ST
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-352-5400
-----------------------------------------------------
Fax | 806-352-8555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | DR. NAEEM U KHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 806-352-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L6235
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------