Healthcare Provider Details

I. General information

NPI: 1740594472
Provider Name (Legal Business Name): SMH PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 BOBCAT VILLAGE CENTER RD SUITE 201
NORTH PORT FL
34288-8997
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-0001
US

V. Phone/Fax

Practice location:
  • Phone: 941-497-8220
  • Fax: 941-497-8239
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

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