Provider Demographics
NPI:1780605865
Name:GAINESVILLE AFTER HOURS CLINIC
Entity type:Organization
Organization Name:GAINESVILLE AFTER HOURS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-373-4107
Mailing Address - Street 1:9111 SW 53RD PL STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3035
Mailing Address - Country:US
Mailing Address - Phone:352-373-4107
Mailing Address - Fax:352-373-2230
Practice Address - Street 1:1050 NW 8TH AVE STE 20
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4998
Practice Address - Country:US
Practice Address - Phone:352-379-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
280423OtherAVMED
38426OtherBCBS