MEDICARE: SHANDS TEACHING HOSPITAL AND CLINICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy
3	3336C0002X	Clinic Pharmacy
4	333600000X	Pharmacy	PH11976	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2011305	OTHER		PK

General Provider Information

NPI Number	:	1265514764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANDS TEACHING HOSPITAL AND CLINICS INC

Provider Business Mailing Address
First Line	:	PO BOX 100303
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0303
Country	:	US
Telephone Number	:	352-627-9045
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 SW ARCHER RD
Second Line	:	RM 2130
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1136
Country	:	US
Telephone Number	:	352-265-0720
Fax Number	:	352-265-0682

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL D. HOLMES
Credential	:
Telephone Number	:	352-733-1500

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	12/31/2025

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Directions to “SHANDS TEACHING HOSPITAL AND CLINICS INC ” Practice Location

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