MEDICARE: WEST FLORIDA MEDICAL ASSOCIATES, P. A

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	261QR1300X	Rural Health Clinic/Center	ME100419	FL
2	261QR1300X	Rural Health Clinic/Center	ME69230	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336454339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST FLORIDA MEDICAL ASSOCIATES, P. A

Provider Business Mailing Address
First Line	:	3404 N. LECANTO HWY
Second Line	:	SUITE C
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465
Country	:	US
Telephone Number	:	352-746-1558
Fax Number	:	352-746-3838

Provider Business Practice Location Address
First Line	:	4363 SOUTH SUNCOAST BLVD
Second Line	:
City	:	HOMOSASSA SPRINGS
State	:	FL
Zip	:	34446
Country	:	US
Telephone Number	:	352-503-2011
Fax Number	:	352-503-6892

Authorized Official
Title or Position	:	PHYSICIAN/DIRECTOR
Name	:	HASIBUL H. KHAN
Credential	:	M.D.
Telephone Number	:	352-503-2011

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	04/10/2013

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Directions to “WEST FLORIDA MEDICAL ASSOCIATES, P. A ” Practice Location

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