Healthcare Provider Details

I. General information

NPI: 1184193161
Provider Name (Legal Business Name): PHYSICIAN ADVISORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 PALM SPRINGS DR
ALTAMONTE SPRINGS FL
32701-7864
US

IV. Provider business mailing address

6785 ARROYO DR
MELBOURNE FL
32940-8516
US

V. Phone/Fax

Practice location:
  • Phone: 855-614-7246
  • Fax: 425-270-3769
Mailing address:
  • Phone: 813-731-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONICA JOHNSON
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 425-941-1360