Healthcare Provider Details

I. General information

NPI: 1356688899
Provider Name (Legal Business Name): PHYSICIAN PARTNERS SPECIALTY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 SW 17TH ST
OCALA FL
34471-1223
US

IV. Provider business mailing address

1714 SW 17TH ST
OCALA FL
34471-1227
US

V. Phone/Fax

Practice location:
  • Phone: 352-274-9900
  • Fax: 352-261-0816
Mailing address:
  • Phone: 352-274-9455
  • Fax: 877-405-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: SRIRAM SUNDARAMOORTHY
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 813-444-5838