Organization
SHANDS AT LAKE SHORE INC
Active
Parent organization
SHANDS AT LAKE SHORE INC
Other names
Shands Surgical Specialists of Lake City
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHANDS AT LAKE SHORE INC
Authorized official
MS. JODI MANSFIELD (SR. VICE PRESIDENT & COO)
(352) 265-0440
Entity
Organization
Contact information
Practice address
755 SW STATE ROAD 47, LAKE CITY, FL 32025-0453
(386) 755-7788
(352) 733-0069
Mailing address
720 SW 2ND AVE, SUITE 360C, GAINESVILLE, FL 32601-6271
(352) 733-0060
(352) 733-0069
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264258101
—
FL
01
—
CK8077
MEDICARE RR
FL
Enumeration date
09/21/2006
Last updated
05/07/2008
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