Healthcare Provider Details

I. General information

NPI: 1235696329
Provider Name (Legal Business Name): CAREFIRST ACO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W COUNTY ROAD 48
BUSHNELL FL
33513-8973
US

IV. Provider business mailing address

1225 W COUNTY ROAD 48
BUSHNELL FL
33513-8973
US

V. Phone/Fax

Practice location:
  • Phone: 352-516-3972
  • Fax:
Mailing address:
  • Phone: 352-516-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SEEMA KHANNA
Title or Position: OWNER
Credential:
Phone: 352-516-3972