MEDICARE: FORTUNE BILLING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1164736310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTUNE BILLING SERVICES

Provider Business Mailing Address
First Line	:	2389 MAIN ST
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-4617
Country	:	US
Telephone Number	:	860-659-6553
Fax Number	:

Provider Business Practice Location Address
First Line	:	2389 MAIN ST
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-4617
Country	:	US
Telephone Number	:	860-659-6553
Fax Number	:

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	NURKEN SENGALIYEV
Credential	:
Telephone Number	:	860-659-6553

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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