SHANDS AT LAKE SHORE INC (NPI# 1730275538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730275538 |
| Entity Type | Organization |
| Organization Name | SHANDS AT LAKE SHORE INC |
| Other Organization Name | LAKE SHORE SPECIALTY GROUP |
| Practice Address |
368 Ne Franklin St Lake City FL 32055-3088 |
| Mailing Address |
720 Sw 2nd Ave Suite 360c Gainesville FL 32601-6271 |
| Practice Telephone | 3867548000 |
| Practice Fax Number | 3527330069 |
| Mailing Telephone | 3527330060 |
| Mailing Fax Number | 3527330069 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2008-05-07 |
| Authorized Official Name | MS. JODI MANSFIELD (SR. VICE PRESIDENT & COO) |
| Authorized Official Telephone | 3522650440 |
| Is Organization Subpart | Y |
| Parent Organization Name | SHANDS AT LAKE SHORE INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 4258 | FL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 264258100 | 05 | |
| FL | MEDICARE RR | CK8077 | 01 |
| Other Name | Type Code |
|---|---|
| Lake Shore Specialty Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497854186 | Shands At Lake Shore Inc | Clinic/Center | 348 Ne Methodist Ter, Suite 101, Lake City, FL 32055-3409 | 2006-09-21 |
| 1366538175 | Shands At Lake Shore Inc | Pharmacy | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2006-10-05 |
| 1871692475 | Shands At Lake Shore Inc | Clinic/Center | 755 Sw State Road 47, Lake City, FL 32025-0453 | 2006-09-21 |
| Street Address |
368 NE FRANKLIN ST |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32055-3088 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457396434 | Paul Richard Schriever | Emergency Medicine | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2006-06-17 |
| 1912410804 | Lake Shore Hma, LLC | Medicare Defined Swing Bed Unit | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2017-11-14 |
| 1295270007 | Columbia Emergency Group LLC | Physician Assistant | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2017-01-03 |
| 1023428539 | Bobbie Lee Rodgers | Pharmacist | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2014-05-06 |
| 1821417502 | Stephen Helvey | Pharmacist | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2014-04-10 |
| 1770902512 | Gregory A Dyle | Pharmacist | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2014-04-09 |
| 1962758342 | Shands Lake Shore Regional Medical Center | General Acute Care Hospital | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2012-08-03 |
| 1346500949 | Foremost Anesthesia Staffing LLC | Anesthesiology | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2012-05-17 |
| 1821317579 | Sergio Bustos Munoz | Pediatrics | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2010-05-20 |
| 1447572037 | Crystal Anne Ferwerda | Pharmacist | 368 Ne Franklin St, Lake City, FL 32055-3088 | 2010-02-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114439510 | Melissa Fay Peters | Nurse Practitioner | 5085 West Us Highway 90, Lake City, FL 32055 | 2017-10-26 |
| 1851801765 | Stephanie Jo Nogle | Occupational Therapist | Brooks Americare: 4251 Nw American Ln, #103, Lake City, FL 32055 | 2017-10-05 |
| 1831617273 | Erica Mayo | Pharmacist | 4846 Nw Lake Jeffery Rd., Lake City, FL 32055 | 2017-09-06 |
| 1144759333 | Jerry Hamilton Cheesman | Dentist | 217 Ne Franklin Sreet, Lake City, FL 32055 | 2017-06-09 |
| 1487183745 | Joshua Allore | Dentist | 2970 W Us Highway 90., Lake City, FL 32055 | 2017-06-08 |
| 1497298418 | Careing Hands | Preferred Provider Organization | 1471nw Queen Rd, Lakecity, FL 32055 | 2016-11-22 |
| 1881148278 | Corniqueca Stewart-simmons | Nurse Practitioner | 340 Nw Commerce Drive, Lake City, FL 32055 | 2016-08-15 |
| 1164809141 | Latasha Harten-jones | Licensed Practical Nurse | 443 Ne Sims Dr, Lake City, FL 32055 | 2015-04-29 |
| 1154716447 | Lindsey Morton | Counselor | 219 Se Baya Avenue, Lake City, FL 32055 | 2015-04-02 |
| 1124439351 | Tynette Jordan | Counselor | 708 N.w Wilson St., Lake City, FL 32055 | 2014-05-09 |
| Find all providers in zip 32055 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.