Provider Demographics
NPI:1225065717
Name:ACUTE CARE PEDIATRICS OF PALM COAST, PA
Entity Type:Organization
Organization Name:ACUTE CARE PEDIATRICS OF PALM COAST, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIU
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:386-447-7337
Mailing Address - Street 1:397 PALM COAST PARKWAY SW
Mailing Address - Street 2:UNIT 303
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137
Mailing Address - Country:US
Mailing Address - Phone:386-447-7337
Mailing Address - Fax:386-447-7348
Practice Address - Street 1:397 PALM COAST PARKWAY SW
Practice Address - Street 2:UNIT 303
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137
Practice Address - Country:US
Practice Address - Phone:386-447-7337
Practice Address - Fax:386-447-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0075674208000000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009USOtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL000387200Medicaid
GAPENDINGMedicare Oscar/Certification
FL43808AOtherBCBS