Provider Demographics
NPI:1093356545
Name:SHIM MEDICAL, LLC
Entity Type:Organization
Organization Name:SHIM MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-814-9251
Mailing Address - Street 1:12780 RACE TRACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1395
Mailing Address - Country:US
Mailing Address - Phone:813-814-9251
Mailing Address - Fax:813-814-9261
Practice Address - Street 1:12780 RACE TRACK RD STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1395
Practice Address - Country:US
Practice Address - Phone:813-814-9251
Practice Address - Fax:813-814-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty