Provider Demographics
NPI:1851943591
Name:ATTESOR MSO LLC
Entity Type:Organization
Organization Name:ATTESOR MSO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEOTIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-237-4412
Mailing Address - Street 1:3350 SW 148TH AVE STE 146
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3257
Mailing Address - Country:US
Mailing Address - Phone:954-237-4377
Mailing Address - Fax:866-653-1953
Practice Address - Street 1:3350 SW 148TH AVE STE 146
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3257
Practice Address - Country:US
Practice Address - Phone:954-237-4377
Practice Address - Fax:866-653-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization