Healthcare Provider Details

I. General information

NPI: 1225065717
Provider Name (Legal Business Name): ACUTE CARE PEDIATRICS OF PALM COAST, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 PALM COAST PARKWAY SW UNIT 303
PALM COAST FL
32137
US

IV. Provider business mailing address

397 PALM COAST PARKWAY SW UNIT 303
PALM COAST FL
32137
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-7337
  • Fax: 386-447-7348
Mailing address:
  • Phone: 386-447-7337
  • Fax: 386-447-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 0075674
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE TIU
Title or Position: OFFICE MANAGER
Credential: LPN
Phone: 386-447-7337