Provider Demographics
NPI:1891824082
Name:ALACHUA IMMEDIATE CARE CENTER
Entity Type:Organization
Organization Name:ALACHUA IMMEDIATE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:FEARING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-462-1327
Mailing Address - Street 1:14819 NW 140 ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14819 NW 140 ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32616
Practice Address - Country:US
Practice Address - Phone:386-462-1327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5310Medicare PIN