Provider Demographics
NPI:1932215571
Name:ANASTASIA FAMILY AND URGENT CARE
Entity type:Organization
Organization Name:ANASTASIA FAMILY AND URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSCIAN
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-825-4747
Mailing Address - Street 1:103 ANASTASIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4503
Mailing Address - Country:US
Mailing Address - Phone:904-825-4747
Mailing Address - Fax:904-825-2885
Practice Address - Street 1:103 ANASTASIA BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4503
Practice Address - Country:US
Practice Address - Phone:904-825-4747
Practice Address - Fax:904-825-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2331Medicare ID - Type Unspecified