Provider Demographics
| NPI: | 1346295292 |
|---|---|
| Name: | SMH PHYSICIAN SERVICES INC |
| Entity Type: | Organization |
| Organization Name: | SMH PHYSICIAN SERVICES INC |
| Other - Org Name: | FIRST PHYSICIANS GROUP |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | MICHELLE |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | SHIREY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 941-917-8720 |
| Mailing Address - Street 1: | PO BOX 947407 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ATLANTA |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 30394-7407 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 941-917-8720 |
| Mailing Address - Fax: | 941-917-1875 |
| Practice Address - Street 1: | 1700 S TAMIAMI TRL |
| Practice Address - Street 2: | 1ST FLOOR FPG ADMINISTRATION |
| Practice Address - City: | SARASOTA |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 34239-3509 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 941-917-8720 |
| Practice Address - Fax: | 941-917-1875 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | SMH PHYSICIAN SERVICES INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-22 |
| Last Update Date: | 2022-05-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
| No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 33181 | Other | BCBS GROUP # |
| FL | 376537700 | Medicaid | |
| FL | 33181 | Medicare PIN | |
| FL | 33181X | Medicare PIN | |
| FL | 33181H | Medicare PIN | |
| FL | 33181R | Medicare PIN | |
| FL | 33181 | Other | BCBS GROUP # |
| FL | AC322A | Medicare PIN | |
| FL | 33181A | Medicare PIN | |
| FL | 33181S | Medicare PIN | |
| FL | 33181T | Medicare PIN | |
| FL | 33181W | Medicare PIN |
