Healthcare Provider Details

I. General information

NPI: 1124014709
Provider Name (Legal Business Name): PHYSICIANS FOR ACCOUNTABLE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 ROLLING ACRES RD STE 1
LADY LAKE FL
32159-5037
US

IV. Provider business mailing address

922 ROLLING ACRES RD STE 1
LADY LAKE FL
32159-5037
US

V. Phone/Fax

Practice location:
  • Phone: 352-674-6300
  • Fax: 353-753-6399
Mailing address:
  • Phone: 352-674-6300
  • Fax: 527-536-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA GROHLER
Title or Position: MANAGER
Credential:
Phone: 352-674-6300