Provider Demographics
NPI:1720751340
Name:SHANDS TEACHING HOSPITAL & CLINICS INC
Entity Type:Organization
Organization Name:SHANDS TEACHING HOSPITAL & CLINICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:352-733-1500
Mailing Address - Street 1:PO BOX 100172
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0172
Mailing Address - Country:US
Mailing Address - Phone:352-627-9045
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-626-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHANDS TEACHING HOSPITAL AND CLINICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-29
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL083921300Medicaid