Healthcare Provider Details

I. General information

NPI: 1396804373
Provider Name (Legal Business Name): SHANDS TEACHING HOSPITAL AND CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4197 NW 86TH TERRACE SUITE 1131
GAINESVILLE FL
32606-6271
US

IV. Provider business mailing address

PO BOX 100303
GAINESVILLE FL
32610-0303
US

V. Phone/Fax

Practice location:
  • Phone: 352-733-0090
  • Fax: 352-733-0098
Mailing address:
  • Phone: 352-627-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH13786
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH13786
License Number StateFL

VIII. Authorized Official

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