Provider Demographics
NPI:1093872889
Name:NORTH FLORIDA IMMEDIATE CARE CENTER
Entity Type:Organization
Organization Name:NORTH FLORIDA IMMEDIATE CARE CENTER
Other - Org Name:IMMEDIATE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:352-333-6227
Mailing Address - Street 1:812 NW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6414
Mailing Address - Country:US
Mailing Address - Phone:352-333-4700
Mailing Address - Fax:352-333-4717
Practice Address - Street 1:812 NW 57TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6414
Practice Address - Country:US
Practice Address - Phone:352-333-4700
Practice Address - Fax:352-333-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6211110000007261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB901ZOtherBCBS FACILITY ID