Provider Demographics
NPI:1861677064
Name:SHC MEDICAL PARTNERS OF FLORIDA, LLC
Entity Type:Organization
Organization Name:SHC MEDICAL PARTNERS OF FLORIDA, LLC
Other - Org Name:INTEGRITAS LTC PRACTITIONERS OF FLORIDA, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-558-2193
Mailing Address - Street 1:805 N WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7101
Mailing Address - Country:US
Mailing Address - Phone:502-630-7532
Mailing Address - Fax:502-568-7135
Practice Address - Street 1:4033 BEAVER LN
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9206
Practice Address - Country:US
Practice Address - Phone:941-625-3200
Practice Address - Fax:941-624-2358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHC MEDICAL PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-07
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ398AMedicare UPIN
FLAJ398Medicare UPIN