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General NPI Number Information
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NPI Number | 1124014709
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Entity Type | Organization
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Legal Business Name | PHYSICIANS FOR ACCOUNTABLE CARE, LLC
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 922 ROLLING ACRES RD STE 1
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City | LADY LAKE
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State | FL
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Zip | 32159-5037
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Country | US
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Telephone | 352-674-6300
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Fax | 353-753-6399
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Provider Business Mailing Address
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Address Line | 922 ROLLING ACRES RD STE 1
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City | LADY LAKE
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State | FL
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Zip | 32159-5037
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Country | US
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Telephone | 352-674-6300
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Fax | 527-536-3993
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Authorized Official
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Title or Position | MANAGER
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Name | REBECCA GROHLER
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Credential |
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Telephone | 352-674-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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