Healthcare Provider Details

I. General information

NPI: 1184723777
Provider Name (Legal Business Name): SHANDS TEACHING HOSPITAL AND CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 NW 48TH TER STE 101
GAINESVILLE FL
32606-7229
US

IV. Provider business mailing address

PO BOX 100303
GAINESVILLE FL
32610-0303
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5230
  • Fax: 352-265-5231
Mailing address:
  • Phone: 352-627-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4286
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL D. HOLMES
Title or Position: CEO
Credential:
Phone: 352-733-1500