Provider Demographics
NPI:1003225475
Name:PHYSICIANS CARE CLINIC LLC
Entity Type:Organization
Organization Name:PHYSICIANS CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:ROVITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-585-1996
Mailing Address - Street 1:4100 S HOSPITAL DR
Mailing Address - Street 2:SUITE #111
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2813
Mailing Address - Country:US
Mailing Address - Phone:954-585-1996
Mailing Address - Fax:954-785-1998
Practice Address - Street 1:4100 S HOSPITAL DR
Practice Address - Street 2:SUITE #111
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2813
Practice Address - Country:US
Practice Address - Phone:954-585-1996
Practice Address - Fax:954-785-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME30354OtherLICENSE