Healthcare Provider Details

I. General information

NPI: 1578659306
Provider Name (Legal Business Name): SHANDS TEACHING HOSPITAL AND CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 E CALL ST
STARKE FL
32091-3616
US

IV. Provider business mailing address

PO BOX 100303
GAINESVILLE FL
32610-0345
US

V. Phone/Fax

Practice location:
  • Phone: 904-368-2300
  • Fax: 352-373-3006
Mailing address:
  • Phone: 352-627-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4267
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number4267
License Number StateFL

VIII. Authorized Official

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