Provider Demographics
NPI:1124014709
Name:PHYSICIANS FOR ACCOUNTABLE CARE, LLC
Entity Type:Organization
Organization Name:PHYSICIANS FOR ACCOUNTABLE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-674-6300
Mailing Address - Street 1:922 ROLLING ACRES RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5037
Mailing Address - Country:US
Mailing Address - Phone:352-674-6300
Mailing Address - Fax:527-536-3993
Practice Address - Street 1:922 ROLLING ACRES RD STE 1
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5037
Practice Address - Country:US
Practice Address - Phone:352-674-6300
Practice Address - Fax:353-753-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC12688OtherRR MEDICARE
FL061970100Medicaid
FLC12688OtherRR MEDICARE