Provider Demographics
NPI:1558595223
Name:SHANDS/SOLANTIC JOINT VENTURE, LLC
Entity Type:Organization
Organization Name:SHANDS/SOLANTIC JOINT VENTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WEBSTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-550-0821
Mailing Address - Street 1:10151 DEERWOOD PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0566
Mailing Address - Country:US
Mailing Address - Phone:904-854-1545
Mailing Address - Fax:
Practice Address - Street 1:720 SW 2ND AVE.
Practice Address - Street 2:160A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-240-8000
Practice Address - Fax:352-377-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
FLN/A261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCO606AMedicare PIN