Provider Demographics
NPI:1891171914
Name:HIGH SPRINGS PEDIATRICS LLC.
Entity Type:Organization
Organization Name:HIGH SPRINGS PEDIATRICS LLC.
Other - Org Name:ALACHUA PEDIATRICS AND PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NASIR
Authorized Official - Middle Name:UDDIN
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-454-1156
Mailing Address - Street 1:14900 NW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-6276
Mailing Address - Country:US
Mailing Address - Phone:386-418-0004
Mailing Address - Fax:386-418-0033
Practice Address - Street 1:14900 NW 140TH ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6276
Practice Address - Country:US
Practice Address - Phone:386-418-0004
Practice Address - Fax:386-418-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-08-11
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
FL277630800Medicaid