Provider Demographics
NPI:1699189449
Name:SMH PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:SMH PHYSICIAN SERVICES INC
Other - Org Name:PAIN MGMT AT HERITAGE HARBOR
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:COO
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 1:1040 RIVER HERITAGE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-6348
Practice Address - Country:US
Practice Address - Phone:941-917-4500
Practice Address - Fax:941-917-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111784207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376537700Medicaid
FL33181OtherBCBS
FL376537700Medicaid