Provider Demographics
NPI:1376505370
Name:SMH PROFESSIONAL SERVICES CORP
Entity Type:Organization
Organization Name:SMH PROFESSIONAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-917-1725
Mailing Address - Street 1:1700 S TAMIAMI TR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-917-1696
Mailing Address - Fax:941-917-2798
Practice Address - Street 1:1700 S TAMIAMI TR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-917-2342
Practice Address - Fax:941-917-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K1653Medicare ID - Type Unspecified