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Organization
PHYSICIAN SERVICES IPA LLC
Active
Organization
PHYSICIAN SERVICES IPA LLC
Active
Parent organization
VAXCARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAXCARE CORPORATION
Authorized official
MR. CASEY B DELOACH (MANAGER)
(888) 829-8550
Entity
Organization
Contact information
Practice address
400 GATLIN AVE, ORLANDO, FL 32806-6940
(888) 829-8550
(888) 843-7191
Mailing address
800 N MAGNOLIA AVE STE 700, ORLANDO, FL 32803-3264
(888) 829-8550
(888) 843-7191
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHC059
MEDICARE PTAN
—
Enumeration date
08/27/2013
Last updated
05/21/2026
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