1326890617 NPI number — SHANDS TEACHING HOSPITAL & CLINICS INC

Table of content: (NPI 1326890617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326890617 NPI number — SHANDS TEACHING HOSPITAL & CLINICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHANDS TEACHING HOSPITAL & CLINICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326890617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100345
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-627-9045
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2051 NW 80TH COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-421-7700
Provider Business Practice Location Address Fax Number:
352-421-7706
Provider Enumeration Date:
04/02/2024

Additional Information

Authorized Official

Authorized Official Last Name:
MOTEW
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
352-733-1500

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PH34948 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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