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SHANDS AT LAKE SHORE INC NPI 1871692475


NPI Information

NPI: 1871692475
Provider Name: SHANDS AT LAKE SHORE INC

Doing Business As: SHANDS SURGICAL SPECIALISTS OF LAKE CITY

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
755 SW STATE ROAD 47
LAKE CITY, FL
ZIP 32025
Phone: (386) 755-7788
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SHANDS AT LAKE SHORE INC is a clinic center in Lake City, FL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). SHANDS AT LAKE SHORE INC NPI is 1871692475. The provider is registered as an organization entity type.
The provider Is Doing Business As Shands Surgical Specialists Of Lake City.

The provider's business location address is:

755 SW STATE ROAD 47
LAKE CITY, FL
ZIP 32025-453
Phone: (386) 755-7788
Fax: (352) 733-0069

The provider's authorized official is Jodi Mansfield .
The authorized official title is Sr. Vice President & Coo and has the following contact phone number (352) 265-0440.

The enumeration date for this NPI number is 9/21/2006 and was last updated on 5/7/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM1300XClinic/CenterMulti-SpecialtyNo
2261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10102AMEDICARE PINFLORIDA
2CK8077OTHERFLORIDAMEDICARE RR
3264258101MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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