Provider Demographics
NPI:1184193161
Name:PHYSICIAN ADVISORS LLC
Entity Type:Organization
Organization Name:PHYSICIAN ADVISORS LLC
Other - Org Name:LASER SPINE BREVARD
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-941-1360
Mailing Address - Street 1:6785 ARROYO DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8516
Mailing Address - Country:US
Mailing Address - Phone:813-731-5143
Mailing Address - Fax:
Practice Address - Street 1:660 PALM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7864
Practice Address - Country:US
Practice Address - Phone:855-614-7246
Practice Address - Fax:425-270-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty