Healthcare Provider Details

I. General information

NPI: 1003866732
Provider Name (Legal Business Name): ACUTE CARE PEDIATRICS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 REID ST
PALATKA FL
32177-3237
US

IV. Provider business mailing address

PO BOX 797
PALATKA FL
32178-0797
US

V. Phone/Fax

Practice location:
  • Phone: 386-328-5437
  • Fax: 386-447-7348
Mailing address:
  • Phone: 386-328-5437
  • Fax: 386-328-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME075674
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DWIGHT L TIU
Title or Position: PHYSICIAN
Credential: MD
Phone: 386-328-5437