Provider Demographics
NPI:1356688899
Name:PHYSICIAN PARTNERS SPECIALTY SERVICES, LLC
Entity Type:Organization
Organization Name:PHYSICIAN PARTNERS SPECIALTY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SRIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARAMOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-444-5838
Mailing Address - Street 1:1714 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1227
Mailing Address - Country:US
Mailing Address - Phone:352-274-9455
Mailing Address - Fax:877-405-0955
Practice Address - Street 1:1714 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1223
Practice Address - Country:US
Practice Address - Phone:352-274-9900
Practice Address - Fax:352-261-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGY021AMedicare PIN