| Physician Services Ipa Llc | |
|
400 Gatlin Ave Orlando FL 32806-6940 | |
| (888) 829-8550 | |
| (888) 843-7191 |
| Full Name | Physician Services Ipa Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 400 Gatlin Ave, Orlando, Florida |
| Authorized Official Name and Position | Casey B Deloach (MANAGER) |
| Authorized Official Contact | 8888298550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Services Ipa Llc 400 Gatlin Ave Orlando FL 32806-6940 Ph: (888) 829-8550 | Physician Services Ipa Llc 400 Gatlin Ave Orlando FL 32806-6940 Ph: (888) 829-8550 |
| NPI Number | 1336573351 |
|---|---|
| Provider Enumeration Date | 08/27/2013 |
| Last Update Date | 08/27/2013 |
| Medicare PECOS PAC ID | 1254660921 |
|---|---|
| Medicare Enrollment ID | O20190905000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336573351 | NPI | - | NPPES |
| PHC059 | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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