Provider Demographics
NPI:1114969995
Name:SHANDS TEACHING HOSPITAL AND CLINICS INC
Entity Type:Organization
Organization Name:SHANDS TEACHING HOSPITAL AND CLINICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:352-733-1500
Mailing Address - Street 1:PO BOX 100345
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1136
Practice Address - Country:US
Practice Address - Phone:352-265-8270
Practice Address - Fax:352-265-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH162443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1084639OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL106549100Medicaid
0877470006Medicare NSC