=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801619689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | F&S RADIOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2024
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11711 LIVINGSTON RD
-----------------------------------------------------
City | FORT WASHINGTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20744-5151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-939-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3371
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46206-3371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-939-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | KAREN MARIE VAUGHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-450-4684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------