Provider Demographics
NPI:1518205723
Name:PHYSICIANS ACCOUNTABLE GROUP, LLC
Entity Type:Organization
Organization Name:PHYSICIANS ACCOUNTABLE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:MR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADORNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-740-0282
Mailing Address - Street 1:6355 NW 36TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7027
Mailing Address - Country:US
Mailing Address - Phone:954-740-0282
Mailing Address - Fax:
Practice Address - Street 1:6355 NW 36TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-7027
Practice Address - Country:US
Practice Address - Phone:954-740-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization