Provider Demographics
NPI:1578659306
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:352-627-9045
Mailing Address - Fax:
Practice Address - Street 1:922 E CALL ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3616
Practice Address - Country:US
Practice Address - Phone:904-368-2300
Practice Address - Fax:352-373-3006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHANDS TEACHING HOSPITAL AND CLINICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4267261Q00000X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257857300Medicaid
FLCD2952OtherMEDICARE RAIL ROAD
FLK1777Medicare PIN