Provider Demographics
NPI:1659640282
Name:ACCOUNTABLE CARE HOSPITALIST GROUP
Entity Type:Organization
Organization Name:ACCOUNTABLE CARE HOSPITALIST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GHIRAGOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-762-1282
Mailing Address - Street 1:1155 S CONGRESS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5114
Mailing Address - Country:US
Mailing Address - Phone:561-766-1300
Mailing Address - Fax:561-693-0539
Practice Address - Street 1:10101 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6103
Practice Address - Country:US
Practice Address - Phone:561-766-1300
Practice Address - Fax:561-693-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103682200Medicaid