Healthcare Provider Details

I. General information

NPI: 1699189449
Provider Name (Legal Business Name): SMH PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER HERITAGE BLVD SUITE 201
BRADENTON FL
34212-6348
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-4500
  • Fax: 941-917-4507
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME111784
License Number StateFL

VIII. Authorized Official

Name: ILENE GILBERT
Title or Position: COO
Credential: COO
Phone: 941-917-8720