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NPI Code Detail

MEDICARE: SHANDS AT LAKE SHORE INC

MEDICARE: SHANDS AT LAKE SHORE 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
1261Q00000XClinic/Center4258FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CK8077OTHERFLMEDICARE RR

Other Identifiers

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

General Provider Information

NPI Number : 1730275538
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHANDS AT LAKE SHORE INC
Provider Business Mailing Address
First Line : 720 SW 2ND AVE
Second Line : SUITE 360C
City : GAINESVILLE
State : FL
Zip : 32601-6271
Country : US
Telephone Number : 352-733-0060
Fax Number : 352-733-0069
Provider Business Practice Location Address
First Line : 368 NE FRANKLIN ST
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-3088
Country : US
Telephone Number : 386-754-8000
Fax Number : 352-733-0069
Authorized Official
Title or Position : SR. VICE PRESIDENT & COO
Name : MS. JODI MANSFIELD
Credential :
Telephone Number : 352-265-0440
Provider Enumeration Date : 10/05/2006
Last Update Date : 05/07/2008

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Directions to “SHANDS AT LAKE SHORE INC ” Practice Location

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