Provider Demographics
NPI:1740594472
Name:SMH PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:SMH PHYSICIAN SERVICES INC
Other - Org Name:NORTH PORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
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:32886-0001
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:2345 BOBCAT VILLAGE CENTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-8997
Practice Address - Country:US
Practice Address - Phone:941-497-8220
Practice Address - Fax:941-497-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376537700Medicaid
FL33181SMedicare PIN