S.a.C. Primary Care LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

OS8237 Issued in FL

Legal business name

S.A.C. PRIMARY CARE LLC

Practice address

2000 Prevatt St
Suite B2
Eustis, FL 32726-6149

Phone

(352) 589-5890

Fax

(352) 589-2589

NPI assigned

Oct 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Suzette Ava Chandler, D.O.

Title

Managing Member of LLC

Phone

(352) 250-3112

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1619166568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "MASCOTTE",
            "state": "FL",
            "postal_code": "347530160",
            "telephone_number": "352-589-5890",
            "fax_number": "352-589-2589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PREVATT ST",
            "address_2": "SUITE B2",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266149",
            "telephone_number": "352-589-5890",
            "fax_number": "352-589-2589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S.A.C. PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "SUZETTE",
        "authorized_official_middle_name": "AVA",
        "authorized_official_title_or_position": "MANAGING MEMBER OF LLC",
        "authorized_official_telephone_number": "352-250-3112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "OS8237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Eustis, FL
• Providers in Eustis, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.