Provider Demographics
NPI:1063403301
Name:SMH PHYSICIAN SERVICES INC
Entity type:Organization
Organization Name:SMH PHYSICIAN SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-917-8720
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-366-9641
Mailing Address - Fax:941-366-6305
Practice Address - Street 1:1215 S EAST AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2342
Practice Address - Country:US
Practice Address - Phone:941-366-9641
Practice Address - Fax:941-366-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376537700Medicaid
FL33181LMedicare PIN