Provider Demographics
NPI:1003866732
Name:ACUTE CARE PEDIATRICS,PA
Entity Type:Organization
Organization Name:ACUTE CARE PEDIATRICS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-328-5437
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-0797
Mailing Address - Country:US
Mailing Address - Phone:386-328-5437
Mailing Address - Fax:386-328-5464
Practice Address - Street 1:1301 REID ST
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3237
Practice Address - Country:US
Practice Address - Phone:386-328-5437
Practice Address - Fax:386-447-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME075674208000000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660218500Medicaid
FL0040XOtherBCBS OF FLORIDA
FL43808OtherBCBS PROVIDER NUMBER
FL660218500Medicaid