Healthcare Provider Details

I. General information

NPI: 1073604914
Provider Name (Legal Business Name): SHANDS JACKSONVILLE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W 8TH ST # 2
JACKSONVILLE FL
32209-6533
US

IV. Provider business mailing address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-9162
  • Fax: 904-244-9166
Mailing address:
  • Phone: 904-244-8675
  • Fax: 904-244-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH21850
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL E GLEASON
Title or Position: VP OF FINANCE AND TREASURER
Credential:
Phone: 904-244-8675