Provider Demographics
NPI:1275770968
Name:SMH PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:SMH PHYSICIAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-917-8720
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:5350 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-5812
Practice Address - Country:US
Practice Address - Phone:941-917-8300
Practice Address - Fax:941-917-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91036207N00000X
FL207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33181OtherBCBS FLORIDA
FL376537700Medicaid
FL376537700Medicaid
FL33181XMedicare PIN