Healthcare Provider Details

I. General information

NPI: 1689665424
Provider Name (Legal Business Name): SMH PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 HILLVIEW ST
SARASOTA FL
34239-3605
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-6260
  • Fax: 941-917-6266
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MICHELLE SHIREY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 941-917-8720