Provider Demographics
NPI:1710438015
Name:HIGH SPRINGS PEDIATRICS AND PRIMARY CARE
Entity Type:Organization
Organization Name:HIGH SPRINGS PEDIATRICS AND PRIMARY CARE
Other - Org Name:ALACHUA PEDIATRICS AND PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:NASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-454-1156
Mailing Address - Street 1:19228 NW US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-8783
Mailing Address - Country:US
Mailing Address - Phone:386-454-1156
Mailing Address - Fax:386-454-1158
Practice Address - Street 1:19228 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-8783
Practice Address - Country:US
Practice Address - Phone:386-454-1156
Practice Address - Fax:386-454-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97945261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007470000Medicaid
FL003432700Medicaid