Provider Demographics
NPI:1699874248
Name:SHANDS TEACHING HOSPITAL AND CLINICS, INC.
Entity type:Organization
Organization Name:SHANDS TEACHING HOSPITAL AND CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOTEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-733-1500
Mailing Address - Street 1:PO BOX 100172
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0172
Mailing Address - Country:US
Mailing Address - Phone:352-627-9045
Mailing Address - Fax:352-627-9049
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0111
Practice Address - Fax:352-627-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4286261QE0700X, 282N00000X, 333600000X
FL4335U00000X
3416A0800X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No333600000XSuppliersPharmacy
No335U00000XSuppliersOrgan Procurement Organization
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF9177OtherMEDICARE RAIL ROAD
FL083921300Medicaid
FL010003000Medicaid
FL083921300Medicaid
FL083921300Medicaid