Provider Demographics
NPI:1699209270
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:FPG ADMINISTRATOR
Authorized Official - Prefix:
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 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 1:1825 DR MARTIN LUTHER KING WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2525
Practice Address - Country:US
Practice Address - Phone:941-952-4123
Practice Address - Fax:941-952-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376537700Medicaid
FL33181OtherBCBS OF FL
FLAC322Medicare PIN