Basic Information
| Provider Information | |||||||||
| NPI: | 1437692688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHANDS TEACHING HOSPITAL AND CLINICS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100345 | ||||||||
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| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526279045 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10435 SE 170TH PL | ||||||||
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| City: | SUMMERFIELD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344918998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522334393 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2016 | ||||||||
| LastUpdateDate: | 10/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | JIMENEZ | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3527331500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X | Y | Laboratories | Physiological Laboratory |
No ID Information.