Provider Demographics
NPI:1396804373
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:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-733-1500
Mailing Address - Street 1:PO BOX 100303
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0303
Mailing Address - Country:US
Mailing Address - Phone:352-627-9045
Mailing Address - Fax:
Practice Address - Street 1:4197 NW 86TH TERRACE
Practice Address - Street 2:SUITE 1131
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6271
Practice Address - Country:US
Practice Address - Phone:352-733-0090
Practice Address - Fax:352-733-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH137863336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDSH100113COther340B NUMBER
FL1396804373OtherNPI NUMBER
FL106077500Medicaid
FLP3733OtherBCBS PROVIDER NUMBER
FL1040308OtherNCPDP NUMBER
FL1040308OtherNCPDP NUMBER