Provider Demographics
NPI:1407891153
Name:NORTH FLORIDA IMMEDIATE CARE CENTERS INC
Entity Type:Organization
Organization Name:NORTH FLORIDA IMMEDIATE CARE CENTERS INC
Other - Org Name:IMMEDIATE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-333-4700
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:352-333-6248
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:352-333-6248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE8007Medicare PIN
FL24624BMedicare PIN