Healthcare Provider Details

I. General information

NPI: 1447523832
Provider Name (Legal Business Name): SMH PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 S TAMIAMI TRL 1ST FLOOR
SARASOTA FL
34239-2930
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-0001
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-5700
  • Fax: 941-917-5784
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME104779
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME104779
License Number StateFL

VIII. Authorized Official

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