Provider Demographics
NPI:1366757825
Name:DR NICK AUSAF FAMILY PRACTICE PA
Entity type:Organization
Organization Name:DR NICK AUSAF FAMILY PRACTICE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NIAZ
Authorized Official - Middle Name:AMER
Authorized Official - Last Name:AUSAF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-402-1001
Mailing Address - Street 1:PO BOX 8057
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-0118
Mailing Address - Country:US
Mailing Address - Phone:863-402-1001
Mailing Address - Fax:863-402-9097
Practice Address - Street 1:5 RYANT BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8075
Practice Address - Country:US
Practice Address - Phone:863-402-1001
Practice Address - Fax:863-402-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty